Optimising thrombolytic therapy in elderly patients with acute myocardial infarction

The incidence of myocardial infarction (MI) and its subsequent mortality increases with age. However, elderly patients are less likely to receive thrombolytic therapy. Among other reasons, this may be because elderly patients with evolving MI often have atypical signs and symptoms and delay their presentation for medical treatment by 2 hours compared with younger patients. The risk of (most often fatal) cerebral bleeding in elderly patients treated with aspirin, heparin and thrombolytic drugs is about 1 to 2 per 1000 patients, and is 2 times higher than in younger patients. In order to decrease the incidence of intracranial haemorrhage in elderly patients with acute MI, thrombolytic treatment should not be recommended in patients at increased risk of cerebral bleeding. Otherwise, the benefit of thrombolytic treatment outweigh the risk; for every 1000 elderly patients treated with thrombolytic drugs, approximately 36 are saved compared with those receiving control treatment.