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April 29, 2003 — Fibrinolytic therapy (intravenous delivery of clot-dissolving drugs) in patients who are 75 years and older with ST-segment-elevation myocardial infarction (STEMI, a type of heart attack) is associated with a reduction in death rates and bleeding on the brain after one year, according to an article in the April 28 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to information in the article, since the late 1980s, reperfusion (opening blocked arteries and restoring circulation and oxygen to parts of the heart) has been the standard treatment for STEMI. Fibrinolytic therapy has been beneficial in some groups of patients with STEMI, but has not been rigorously studied in older populations. However, there is concern that use of thrombolytic therapy in the elderly may be associated with increased risk of fatal bleeding events, such as bleeding in the brain.
Ulf Stenestrand, M.D., of University Hospital of Linkoping, Linkoping, Sweden, and colleagues studied the use of fibrinolytic therapy in 6,891 patients 75 years old or older who had previously experienced a STEMI. Of the patients, 3,897 received fibrinolytic therapy and 2,994 did not receive fibrinolytic treatment. Patients were selected from the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions which recorded every patient admitted to a coronary care unit in 64 Swedish hospitals during 1995 through 1999.
The researchers found that fibrinolytic therapy was associated with a 13 percent reduction in the combined endpoints of death and brain bleeding complications after one year.
"The main message from this large-scale registry study is that, in the majority of elderly patients, fibrinolytic therapy is associated with better outcome in the combined end point of one-year mortality and bleeding complications," the authors write. "Until results from randomized trials on fibrinolytic therapy in this age group become available, there is no reason to withhold this treatment from the elderly because of age, at least not before the age of 85 years. On the contrary, our study, in an unselected STEMI population, indicates that fibrinolytic therapy might be lifesaving also in patients who are 75 years and older."
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