MANAGEMENT OF PATIENTS WHO REQUIRE INVASIVE PROCEDURES IMMEDIATELY FOLLOWING THROMBOLYTIC THERAPY

In recent years the use of thrombolytic therapy has been demonstrated to be valuable in the treatment of patients with acute myocardial infa rction. Often, because of the frequency of reocclusion of the infarct- related artery, identification of a treatable vascular lesion, or, rar ely, failure of thrombolytic therapy, patients will require more invas ive procedures to prevent further ischemic injury to the myocardium. T hese procedures include anything from cardiac catheterization to emerg ency coronary bypass surgery. The perioperative evaluation and managem ent of patients who have recently received thrombolytic therapy requir es an understanding of the changes in coagulation proteins that occur with the use of these therapeutic agents. The appropriate understandin g and use of antifibrinolytic agents and blood products will allow for these procedures to be performed safely with a minimum of bleeding co mplications.