Experience with the use of tPA in the treatment of acute myocardial infarction.

Published

Journal Article (Review)

Early experience with the use of tissue plasminogen activator (tPA) in acute myocardial infarction is reviewed, including comparisons with other thrombolytic agents, a summary of hemorrhagic complications associated with its use, and the rationale for adjunctive therapeutic strategies. The use of tPA has been associated with improvement in left ventricular function, a lower mortality, and a decrease in congestive heart failure signs and symptoms. A protocol for evaluation of patients with possible myocardial infarction for thrombolytic therapy is presented. Consideration must be given to other possible diagnoses, and the ECG must be evaluated carefully to ensure that appropriate criteria are met. Risk factors for hemorrhagic complications include recent trauma, surgery, gastrointestinal and genitourinary bleeding, stroke, and focal neurologic findings. Greater benefit of therapy is expected in patients with larger infarcts who have more marked ST segment changes or evidence of hemodynamic compromise, especially when they are treated early after the onset of symptoms (within the first several hours). Adjunctive measures that can be considered in the emergency department include prophylactic lidocaine, IV nitroglycerin, beta blockade, aspirin, volume replacement and monitoring for dysrhythmias, bleeding, and recurrent ischemia. A comprehensive understanding of these rapidly evolving concepts will assist the emergency physician in the evaluation and management of patients with acute myocardial infarction.

Full Text

Duke Authors

Cited Authors

  • Califf, RM; Mantell, S; Westawski, C; Bride, W; Honan, MB; Bellinger, RL; Wall, TC

Published Date

  • November 1988

Published In

Volume / Issue

  • 17 / 11

Start / End Page

  • 1176 - 1189

PubMed ID

  • 2973270

Pubmed Central ID

  • 2973270

Electronic International Standard Serial Number (EISSN)

  • 1097-6760

International Standard Serial Number (ISSN)

  • 0196-0644

Digital Object Identifier (DOI)

  • 10.1016/s0196-0644(88)80064-7

Language

  • eng