THROMBOLYTIC THERAPY OF ACUTE MYOCARDIAL- INFARCTION IN VERY ELDERLY PATIENTS (A REPORT ON 2 CASES)

The introduction of thrombolysis has reduced the mortality of acute my ocardial infarction (MI) by 25%. Large-scale studies have revealed tha t especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the h igher risk of stroke or bleeding in elderly patients. In 1993 181 pati ents suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patien ts (87 and 88 years old) who were treated with 100 mg recombinant tiss ue-type plasminogen activator complex. As a sign of successful reperfu sion a rapid increase in plasma creatinine kinase levels and fast amel ioration of the ischemia-related ECG changes were observed. In the fol low-up examination after four months the first patients showed only mi nimal exertional dyspnea and was otherwise well. The second patient di ed one month after MI following a laparotomy for ileus. We draw the co nclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and cont raindications have to be carefully observed.