TAILORED THROMBOLYTIC THERAPY - A PERSPECTIVE

Citation
Ml. Simoons et Aer. Arnold, TAILORED THROMBOLYTIC THERAPY - A PERSPECTIVE, Circulation, 88(6), 1993, pp. 2556-2564
Citations number
73
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2556 - 2564
Database
ISI
SICI code
0009-7322(1993)88:6<2556:TTT-AP>2.0.ZU;2-C
Abstract
Background. In contrast with current standard regimens, it seems more appropriate to tailor thrombolytic therapy to individual patient chara cteristics. A proposed model for such tailored therapy is based on ind ividual assessment of benefits and risks of thrombolytic therapy, taki ng into account the response of individual patients to the therapy giv en. Methods and Results. Potential benefits of thrombolysis in individ ual patients can be predicted by use of demographic patient characteri stics (age, sex, history of previous infarction) together with indicat ors of the ischemic area at risk (total ST segment deviation) and trea tment delay. Using these parameters, the number of ''lives saved'' by thrombolytic therapy for specific patient characteristics can be estim ated. Similarly, the risk of intracranial hemorrhage during thrombolyt ic therapy can be estimated from the patient's age, blood pressure at admission, and body weight. Depending on benefit/risk estimates, a cho ice can be made between regimens with high, medium, or modest thrombol ytic efficacy. Continuous multilead ECG ischemia monitoring and rapid assays of myocardial proteins in serum can be used to assess the occur rence or absence of reperfusion and to detect signs of reocclusion. Su ch data help to decide whether thrombolytic therapy should be continue d or intensified or might be discontinued in individual patients befor e the total standard dose has been administered. Such tailored reducti on of the total thrombolytic dose will reduce the risk for bleeding co mplications in some of the patients. Conclusions. The concept of tailo ring thrombolytic therapy and the models presented for benefit/risk as sessment should be tested in clinical studies and may subsequently hel p the physician to select the optimal approach in individual patients.