INTRACRANIAL HEMORRHAGE RISK AND NEW THROMBOLYTIC THERAPIES IN ACUTE MYOCARDIAL-INFARCTION

Citation
Wb. Hillegass et al., INTRACRANIAL HEMORRHAGE RISK AND NEW THROMBOLYTIC THERAPIES IN ACUTE MYOCARDIAL-INFARCTION, The American journal of cardiology, 73(7), 1994, pp. 444-449
Citations number
30
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
00029149
Volume
73
Issue
7
Year of publication
1994
Pages
444 - 449
Database
ISI
SICI code
0002-9149(1994)73:7<444:IHRANT>2.0.ZU;2-7
Abstract
Thrombolytic therapy for acute myocardial infarction (AMI) has reduced mortality at the expense of additional intracranial hemorrhages. To d etermine whether this trade-off has been optimized, a decision analysi s was performed using pooled data to determine the further reductions in mortality required to justify increased intracranial hemorrhage rat es from more potent thrombolytic and adjunctive antithrombotic regimen s than intravenous streptokinase. Pooled data from large clinical tria ls suggest that streptokinase has a 0.07% nonfatal intracranial hemorr hage rate. Approximately 54% of these result in major/moderate disabil ity and 46% in recovery or minor residual. The early mortality rate in all AMI patients treated with thrombolytic therapy is 9.8%; it is 6.8 % in patients with inferior wall AMI and 17.9% in elderly patients. If a new thrombolytic regimen provides a 1% absolute reduction in early mortality compared with streptokinase therapy, approximately a greater than or equal to 3.2% nonfatal intracranial hemorrhage rate is justif ied to obtain this survival benefit. For a 10% relative reduction in m ortality risk, the maximal acceptable nonfatal intracranial hemorrhage rates are 2.2% for inferior wall AMI, 3.2% for all patients and 5.9% for elderly patients. Whereas intracranial hemorrhage is a catastrophi c complication of thrombolytic therapy in the treatment of patients wi th AMI, thrombolytic regimens that result in significantly higher rate s of intracranial hemorrhage than those observed with streptokinase ma y be preferable at surprisingly smaller additional reductions in morta lity. In addition to evaluating new thrombolytic and antithrombotic re gimens, this analysis, in conjunction with models that predict patient -specific intracranial hemorrhage risks and mortality benefits from th rombolytic therapy, can Provide a framework for matching AMI patients with optimal thrombolytic regimens.