Thrombolytic therapy and cocaine-associated acute myocardial infarction

The role of thrombolytic therapy in patients with cocaine-associated acute myocardial infarction (AMI) is controversial. Some have suggested that beca use the AMI mortality may be low in young patients with cocaine usage, the risks outweigh the benefits of thrombolytic therapy. Two cases of cocaine-a ssociated AMI are presented. Each case illustrates different aspects of thi s controversy, In one case, ECG interpretation and concerns with thrombolyt ic therapy in this setting led to prolonged treatment delay. The second cas e illustrates unrecognized cocaine-associated AMI treated safely with throm bolytic therapy and beta-blockade. The arguments for and against thrombolyt ic therapy in this setting are discussed. The available literature suggesti ng increased risk associated with thrombolytic therapy in patients with coc aine-associated AMI is critically reviewed. Copyright (C) 2000 by W.B. Saun ders Company.