Fibrinolysis for Acute Myocardial Infarction in the Elderly Patient: Is it Effective or Too Dangerous?

The incidence of myocardial infarction, and the subsequent mortality and morbidity increases markedly with age. Randomized placebo-contolled trials of fibrinolytic therapy have lacked adequate statistical power due to the relatively small numbers of older patients enrolled, but nevertheless have strongly suggested a mortality benefit in the older age group. Despite this, fibrinolytic therapy remains under-utilized in older patients, largely due to a perception that the risk, particularly of intracranial hemorrhage, outweighs any potential benefit of treatment. While the risk of intracranial hemorrhage following fibrinolysis does increase with age, the net clinical benefit, or the combined endpoints of death or disabling stroke, is still lower with treatment than without. Therapy with t-PA confers the greatest net clinical benefit in all but the very elderly. Age alone should not be a contraindication to fibrinolytic therapy for acute myocardial infarction.

Duke Scholars

Author Robert M. Califf Medicine, Cardiology