Incidence of vascular stroke in patients with acute myocardial infarction receiving fibrinolytic treatment

Aims The benefits of fibrinolytic therapy in reducing mortality of patients with suspected acute myocardial infarction (AMT) are well established. The extent to which fibrinolytic therapy is also associated with an increased incidence of haemorrhagic stroke required investigation. Methods and results A subgroup analysis of the TIM (Triflusal In Myocardial infarction) study was carried out in patients who had undergone fibrinolyt ic treatment, to establish the effect of antiplatelet agents upon the incid ence of stroke. Seventy per cent of 2275 patients with AMI, randomized to r eceive 600 mg of triflusal or 300 mg of aspirin once daily for 35 days, rec eived fibrinolytic therapy. Nineteen patients (1.3%) receiving fibrinolytic treatment suffered strokes during the treatment period. The incidence of s troke was significantly lower for patients treated with r-tPA and triflusal compared with those receiving r-tPA plus aspirin (P=0.03). This finding wa s attributed to a reduced incidence of haemorrhagic strokes in the triflusa l group (0% vs 1.6% in the aspirin group; P=0.01). No significant differenc e in total stroke incidence, or in the incidence of haemorrhagic stroke, wa s observed between triflusal and aspirin when either agent was administered in addition to streptokinase treatment. Conclusion The results suggest that triflusal may be associated with a lowe r rate of haemorrhagic stroke in patients receiving fibrinolytic therapy wi th r-tPA.