OPTIMIZING THROMBOLYTIC THERAPY IN ELDERLY PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

The incidence of myocardial infarction (MI) and its subsequent mortali ty increases with age. However, elderly patients are less likely to re ceive thrombolytic therapy. Among other reasons, this may be because e lderly patients with evolving MI often have atypical signs and symptom s and delay their presentation for medical treatment by 2 hours compar ed with younger patients. The risk of (most often fatal) cerebral blee ding in elderly patients treated with aspirin, heparin and thrombolyti c 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 intracrania l haemorrhage in elderly patients with acute MI, thrombolytic treatmen t should not be recommended in patients at increased risk of cerebral bleeding. Otherwise, the benefit of thrombolytic treatment outweighs t he risk; for every 1000 elderly patients treated with thrombolytic dru gs, approximately 36 are saved compared with those receiving control t reatment.