Bolus fibrinolysis: risk, benefit, and opportunities

摘要: Fibrinolytic therapy for acute ST-segment elevation myocardial infarction has made a major contribution to the care of thousands patients worldwide.1 Over past decade, there have been tremendous advances in such patients, including an enhanced assessment both risks and potential complicating intracranial hemorrhage (ICH), more effective reperfusion strategies, commensurate improvements approach primary angioplasty stenting.2 3 4 Recently, meta-analysis phase III megatrials involving several different fibrinolytic agents used suggested that administered as bolus are associated with excess risk ICH.5 The advantages long-acting, third-generation simple, single- or double-bolus injection substantial when compared prior require sustained infusions often introduced by bolus, without step-down infusion. Within contemporary emergency departments, physicians nurses required deal growing increasingly complicated array available therapies, not only coronary syndromes, but many other conditions well. These demands accented resource constraints; hence, simple regimens welcome innovation those healthcare workers on front lines, less likely engender medication errors. However, relationship between dosing errors morbidity mortality is complex. Thus, whereas higher frequency modest was identified after recombinant tissue-type plasminogen activator (rt-PA) than tenecteplase (TNK-tPA) Assessment Safety New Thrombolytic (ASSENT) 2 study 30-day also incorrect rt-PA this study, evident whether received placebo.6 This analysis emphasizes important role confounding factors …