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European Heart Journal 1989 10(1):16-23;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Bleeding after thrombolysis in acute myocardial infarction

H.-H. ERLEMEIER, W. ZANGEMEISTER*, L. BURMESTER, J. SCHOFER, D.-G. MATHEY and W. BLEIFELD

Department of Cardiology Hamburg West Germany
*Department of Neurology University Hospital Eppendorf Hamburg West Germany

Received 18 December 1987; revised 13 July 1988; .

Address for reprints: Dr Hans-Hermann Erlemeier, Abteilung Kardiologie, Universitü tskrankenhaus Eppendorf, Martinistraße 52, D-2000 Hamburg 20, Federal Republic of Germany.

Abstract

232 consecutive patients with acute myocardial infarction were treated either with 2 x 106 IU urokinase as an intravenous bolus injection, or 250000 IU streptokinase intracoronary, or 60 mg recombinant tissue-type plasminogen activator (rt-PA) over 90 min. All patients enrolled had chest pain for more than 30 min and less than 3 h before admission and a typical electrocardiogram. Contra-indications to thrombolytic treatment were absent. All bleeding complications occurring within 24 h after admission were assumed to be due to thrombolytic therapy. Bleeding complications occurred in 14 patients (6.5%). Only seven patients received a blood transfusion (3%). No correlation was evident between previous hypertension, diabetes mellitus, smoking, sex, age, fibrinogen level before and 24 h after thrombolytic therapy and bleeding complications. The risk of bleeding was not significantly different between the different thrombolytic regimens despite marked differences in the fall of the fibrinogen level. The decrease of fibrinogen following thrombolytic therapy did not influence the patency rate of the infarct vessel. Thrombolytic therapy in acute myocardial infarction is a safe treatment even among patients advanced in years and with medically controlled hypertension and diabetes mellitus, irrespective of the kind of thrombolytic treatment.

Key Words: Myocardial infarction • Thrombolysis • complications


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