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Is there an age limit for thrombolytic therapy?
1Cardiac Department, John Radcliffe Hospital, Oxford, United Kingdom.
Thrombolytic therapy has revolutionized the treatment of acute myocardial infarction. The mortality of infarction increases very steeply with increasing age > 65 years. One-month mortality in such patients is in the range of 20-30%. The proportional benefit of lytic treatment is somewhat less in these older patients, but since mortality is high, the absolute benefit is as large or larger than that in younger patients. The risks of stroke due to thrombolysis are balanced between increased risk of cerebral hemorrhage but decreased risk for ischemic/embolic stroke. This trade-off results, overall, in a slightly increased stroke rate of about 1-2 per 1,000 nonfatal strokes, but with about 20 fewer deaths per 1,000 myocardial infarctions. In addition to these striking mortality benefits, there are also important reductions in infarct size, leading to decreased morbidity from heart failure or arrhythmias.
Thrombolytic therapy has revolutionized the treatment of acute myocardial infarction. The mortality of infarction increases very steeply with increasing age > 65 years. One-month mortality in such patients is in the range of 20-30%. The proportional benefit of lytic treatment is somewhat less in these older patients, but since mortality is high, the absolute benefit is as large or larger than that in younger patients. The risks of stroke due to thrombolysis are balanced between increased risk of cerebral hemorrhage but decreased risk for ischemic/embolic stroke. This trade-off results, overall, in a slightly increased stroke rate of about 1-2 per 1,000 nonfatal strokes, but with about 20 fewer deaths per 1,000 myocardial infarctions. In addition to these striking mortality benefits, there are also important reductions in infarct size, leading to decreased morbidity from heart failure or arrhythmias.