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Thrombolytic therapy for unstable angina
S Borzak1, J Verter, H S Bajwa
1Henry Ford Heart & Vascular Institute, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202.
Clinical Cardiology
|September 1, 1993
Summary
Thrombolytic therapy for unstable angina (UA) shows a trend toward fewer clinical events but increases bleeding complications. Larger trials are needed to determine its net clinical value in treating UA.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Unstable angina (UA) pathogenesis involves intracoronary thrombus formation.
- Thrombolytic therapy is standard for myocardial infarction but not widely accepted for UA.
Purpose of the Study:
- To review the clinical value of thrombolytic therapy for unstable angina.
- To assess the efficacy and safety of thrombolytic agents in UA patients.
Main Methods:
- Review of evidence supporting thrombus formation in UA.
- Analysis of studies on thrombolytic therapy's angiographic and clinical endpoints.
- Synthesis of data from twelve randomized controlled trials in 611 UA patients.
Main Results:
- Thrombolytic therapy reduced angiographically detected thrombus but had minimal effect on luminal narrowing.
- A trend towards fewer clinical events (death, infarction, revascularization) was observed in treated patients.
- Increased bleeding complications were noted in patients receiving thrombolytic therapy.
Conclusions:
- The clinical efficacy of thrombolytic therapy for UA cannot be definitively excluded.
- Insufficient patient numbers in existing trials may limit definitive conclusions.
- Larger, more definitive trials are required to establish the net clinical value of thrombolytic therapy for unstable angina.