Targeting new thrombolytic regimens at specific patient groups: implications for research and cost-containment

European Heart Journal
A Maseri, F Andreotti

Abstract

Fibrinolytic drugs and aspirin, compared with placebo, have reduced the 35-day mortality of patients with acute myocardial infarction from approximately 12% to about 8%. The mortality reduction with active treatment is most evident in high risk groups of patients. Moreover, mortality with a fully patent infarct-related artery at 90 min from the start of thrombolytic treatment is half that found with an occluded artery. Yet more than 50% of acute infarct patients receiving thrombolysis fail to achieve complete early coronary patency or develop re-occlusion. Although thrombolytic strategies are continually evolving to try to further reduce early mortality and increase coronary reperfusion rates, new regimens, when tested in unselected patients against successful active treatments, such as streptokinase and aspirin, are likely to show no, or only small, average benefits, even when applied to tens of thousands of patients. In contrast, the effect of a new thrombolytic regimen is likely to be most evident is selected patients showing large areas of potentially salvageable ischaemic myocardium, as these patients have a higher absolute risk of premature death than patients with smaller infarcts and therefore should gain greater benefi...Continue Reading

Citations

Apr 30, 1999·Emerging Infectious Diseases·C K SchmittA D O'Brien
Jun 2, 2012·Current Opinion in Microbiology·Sabine Pellett
May 1, 2021·Journal of Clinical Medicine·Felicita AndreottiGiovanni Scambia

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