Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Thrombolytic therapy: economic considerations.
Explore the source record for details and available documents.
Cost of Illness↗
SEARCH · Search PubMed
Results for “Thrombolytic Therapy”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Time as an Adjunctive Agent to Thrombolytic Therapy.
Thrombolytic therapy has dramatically reduced mortality following acute myocardial infarction (MI) with the major effect coming from early achievement of infarct-related artery patency. A major factor in achieving rapid reperfusion is early treatment with thrombolytic therapy. Recent trials have shown that mortality can be reduced if time to treatment is shortened: In the Thrombolysis in Myocardial Infarction (TIMI) 2 trial, for each hour earlier that thrombolytic therapy was started, approximately 10 lives were saved per 1000 patients treated. Thus, one must consider time as an adjunctive agent to thrombolytic therapy. There are four components of the time delay between the onset of MI and achievement of reperfusion: (1) patient delays in seeking medical attention; (2) transport delays; (3) the so-called door to needle time, the interval between the patient's arrival at the medical facility and the initiation of thrombolytic therapy; and (4) thrombolytic reperfusion time, the time between the administration of thrombolytic therapy and the achievement of roperfusion, Efforts to reduce each of these components will lead to additive benefits in improving time to reperfusion and survival of patients with acute MI.
Journal Article↗
[Thrombolytic therapy].
Thrombolytic therapy in patients with acute coronary syndrome is not so widely used compared to coronary intervention, such as PTCA or stenting in Japan. This is probably because of the facts that the narrowing of the coronary artery is not completely restored after the thrombolytic therapy and that the coronary intervention is frequently necessary inspite of the administration of the thrombolytic agent. However, the thrombolytic therapy can be easily done in the peracute stage of myocardial infarction, and improvement of the prognosis of the affected patient may be possible. In this paper, the concepts as well as the effect of thrombolytic therapy and the characteristics of newly developed thrombolytic drugs are discussed.
Acute Disease↗
Should general practitioners give thrombolytic therapy?
Thrombolytic therapy reduces mortality from acute myocardial infarction. Moreover the earlier thrombolytic therapy is given after the development of infarction the greater the benefit. It is usual to start thrombolysis only after the patient has been admitted to hospital. In this article we discuss whether thrombolytic therapy should be started by the GP.
Emergency Medical Services↗
Pulmonary thromboembolism with massive vaginal bleeding due to thrombolytic therapy.
Thrombolytic therapy may reduce the morbidity of pulmonary thromboembolism (PTE) and the risk of recurrent disease. The most important complication of thrombolytic therapy is bleeding. We report a patient with PTE complicated by massive vaginal bleeding due to thrombolytic therapy.
Abortion, Induced↗
Hemorrhagic disorders associated with thrombolytic therapy.
Thrombolytic treatment for AMI, acute ischemic stroke, and massive pulmonary embolism has shown significant benefit. Along with the potential increase in perfusion and decrease in cell death, however, comes potential complications. Bleeding is the most common complication associated with thrombolytic therapy regardless of the particular agent and can range from minor bleeding from an i.v. site to a life-threatening hemorrhage, such as GI bleeding. Expert assessment and management of patients who develop bleeding complications is critical to desired patient outcomes. Knowledge of the diagnosis for which a thrombolytic agent is used, pathophysiology, hemodynamic changes, and symptoms of complications associated with bleeding, all present a challenge to nurses. Research-based algorithms, protocols, or standardized treatment plans and a multidisciplinary approach to thrombolytic therapy provide the best opportunity for success, reducing the risk and enhancing early intervention of complications. Although thrombolytic therapy creates its own set of challenges, the alternative--failure to restore perfusion to the myocardium, brain, or pulmonary vasculature--presents both a different set of challenges and a dismal outcome.
Algorithms↗
Direct thrombin inhibitors as adjuncts to thrombolytic therapy.
Thrombolytic therapy aims to achieve rapid and sustained infarct-related artery patency, although this results in a procoagulant state. Heparin has limitations as an antithrombin agent, which has led to clinical investigation of alternative agents. Direct thrombin inhibitors, as adjuncts to thrombolytic therapy, have been shown to increase 90 minute Thrombolysis in Myocardial Infarction (TIMI)-3 flow rates and reduce reinfarction, when compared with heparin. These results have been achieved with an acceptable risk of bleeding, when administered in appropriate dosing regimens. When the direct thrombin inhibitor hirudin was administered at a mean of 34 and 50 minutes after thrombolytic therapy in large clinical trials, there was no reduction in mortality. In contrast, in several angiographic studies, direct thrombin inhibitors were administered prior to thrombolysis. The effect on mortality of the administration of hirulog prior to streptokinase is currently being examined.
Antithrombins↗
Laboratory parameters to monitor safety and efficacy during thrombolytic therapy.
Thrombolytic therapy is being used with increasing frequency in myocardial infarction (MI), pulmonary embolism, deep venous thrombosis (DVT), and peripheral arterial occlusion. Use of these agents, however, is hampered by concerns regarding safety and efficacy. Numerous laboratory parameters have been evaluated for monitoring the risk of bleeding complications, with levels of fibrinogen (and percentage of decrease) and fibrin/fibrinogen degradation products (FDPs) correlating to a variable extent with clinical bleeding. The bleeding time (BT) test has also been proposed as a potential predictor of bleeding during thrombolytic therapy. With respect to efficacy, the D-dimer fragment of FDPs, when corrected for soluble fibrin polymers, has been shown to correlate with clot lysis in venous thromboembolism but not MI. The BT also is being considered as a marker of lysis in patients with DVT. Given the increasing concomitant use of antiplatelet agents during thrombolytic therapy, the BT, as an in vivo test of hemostasis and platelet function, has potential utility as a noninvasive, adjunctive marker of thrombolytic efficacy.
Fibrinolytic Agents↗
Breast Hematoma Complicating Thrombolytic Therapy.
Thrombolytic therapy (TT) is now established as the main treatment of acute myocardial infarction (MI). Spontaneous breast hematoma, usually a rare complication of anticoagulant therapy, has been described in the last five decades, but not after thrombolytic therapy. We present three patients who developed the rare complication of breast hematoma after TT, out of 495 women treated with TT in ICCU in our hospital, because of acute MI in the last 12 years. One patient needed blood transfusion and in another patient, atypical ductal nuclei were observed in fine needle aspiration (FNA) of breast hematoma, needing further evaluation. As thrombolytic therapy becomes more widespread and essential in treating patients suffering acute occlusion of coronary, retinal, pulmonary or peripheral arteries, it is expected that more women will present with breast hematoma following such treatment.
Journal Article↗
Myocardial salvage: thrombolytic therapy.
Thrombolytic therapy for acute myocardial infarction is an important advance in patient care. The intravenous administration of tissue plasminogen activator appears to be the most promising combination of route and agent but may need to be coupled with more definitive measures. Although the prehospital use of thrombolysis is largely unexplored, the interhospital use appears to be safe and effective. The administration of thrombolytic therapy must be a coordinated effort between the emergency physician and the cardiologist. Indications for thrombolytic therapy are still evolving and adverse effects will no doubt increase in incidence once the availability and use of effective thrombolytic agents is widespread. The emergency physician, especially, needs to tread the fine line between "minutes are myocardium" and "haste makes waste."
Fibrinolytic Agents↗
Acute myocardial infarction: strategies for thrombolytic therapy.
Thrombolytic therapy has revolutionised the treatment of acute myocardial infarction. This has led to a need for rapid and accurate diagnosis of this condition, provision of a triage protocol to achieve initiation of thrombolytic therapy as soon as the diagnosis has been made, and knowledge of the benefit:risk ratio of thrombolytic therapy in different subgroups of patients to allow the most effective use of these agents without compromising patient safety.
Electrocardiography↗
A history of thrombolytic therapy.
Thrombolytic therapy has been available for the last 5 decades, but the modern era of thrombolysis began in the early 1990s, with the execution of 3 multicenter trials designed to compare this potentially less invasive therapy to the then standard of care for acute limb ischemia, open surgical revascularization. Even with the development of several bio-engineered lytic agents, the major risk of thrombolytic therapy continues to be bleeding complications. Nevertheless, data exist to suggest that thrombolysis should be considered as an adjunct to open surgery, percutaneous interventions, or, occasionally, as sole therapy for acute vascular occlusion. This review summarizes the developmental milestones in the history of thrombolysis and reviews data supporting its use in acute arterial occlusions.
Fibrinolytic Agents↗
Methods to limit reinfarction and ischemia after thrombolytic therapy.
Thrombolytic therapy has greatly influenced the long-term outcome of thousands of patients suffering AMI. The incidence of reocclusion and recurrent ischemia are continuing problems that need to be confronted if thrombolytic therapy is to have its full impact on the care of these patients. Clinical studies are providing more information on the best adjunctive therapy to accompany thrombolysis. Nursing has the potential to improve the outcome of patients by assuring the methods of preventing reocclusion we have available are skillfully implemented. If reocclusion occurs, nurses can identify the event and initiate treatment before substantial myocardium is lost. In the future, noninvasive methods to identify which patients will reocclude may be available. Thrombolytic "cocktails" or medications such as antiplatelet antibodies may be useful and may abolish reocclusion completely.
Humans↗
Hemorrhagic complications of thrombolytic therapy.
Thrombolytic therapy salvages ischemic myocardium by rapidly reestablishing coronary artery patency in acute myocardial infarction. One of its major limitations is the complication of hemorrhage. A retrospective study of myocardial infarction patients who received thrombolytic therapy was performed to determine risk factors associated with a hemorrhagic event. Three hundred fifty patients were enrolled, and 20 (5.7%) had a bleeding complication, including four patients (1.1%) who had an intracranial hemorrhage. The factors associated with an increased risk for a significant hemorrhagic event were age (> 65 years) and female gender. Factors associated with an intracranial hemorrhage were age (> 65 years) and a history of hypertension.
Aged↗
Anesthetic care of a patient with an intracranial hemorrhage after thrombolytic therapy.
Thrombolytic therapy is being used with increasing frequency to treat acute myocardial infarction (MI). It is important for both the general and cardiac anesthesiologist to understand the effects of thrombolysis on hemostasis and myocardial function, since these patients can present for emergent surgery in the cardiac or general operating theater. The authors report a case of a patient who developed an intracranial hemorrhage following thrombolytic therapy that required emergency surgical intervention.
Anesthesia, Intravenous↗
[Atherosclerosis obliterance; thrombolytic therapy].
Thrombolytic therapy used to be considered ineffective for chronic arteriosclerotic obiterance. However, direct infusion of a thrombotic agent into the thrombus through a vascular catheter was shown to be more effective than expected. We have performed high-dose intra-thrombotic urokinase injection for arteriosclerotic obiterance of iliac and femoropopliteal arterial region since 1985. In this procedure, urokinase is infused at 10,000 unit/ minute through a catheter inserted into the thrombus. In the 65 lesions treated by this method, the initial success rate was 85%, and the cumulative 1-year patency rate was 72%. The mean total dose of urokinase was 620,000 units. Here we discussed thrombolytic therapy for chronic arteriosclerosis obliterance based on our experience.
Arteriosclerosis Obliterans↗
Individual risk assessment for intracranial haemorrhage during thrombolytic therapy.
Thrombolytic therapy improves outcome in patients with myocardial infarction but is associated with an increased risk of intracranial haemorrhage. For some patients, this risk may outweigh the potential benefits of thrombolytic treatment. Using data from other studies, we developed a model for the assessment of an individual's risk of intracranial haemorrhage during thrombolysis. Data were available from 150 patients with documented intracranial haemorrhage and 294 matched controls. 49 patients with intracranial haemorrhage and 122 controls had been treated with streptokinase, whereas 88 cases and 148 controls had received alteplase. By multivariate analysis, four factors were identified as independent predictors of intracranial haemorrhage; age over 65 years (odds ratio 2.2 [95% Cl 1.4-3.5]), body weight below 70 kg (2.1 [1.3-3.2]), hypertension on hospital admission (2.0 [1.2-3.2]), and administration of alteplase (1.6 [1.0-2.5]). If the overall incidence of intracranial haemorrhage is assumed to be 0.75%, patients without risk factors who receive streptokinase have a 0.26% probability of intracranial haemorrhage. The risk is 0.96%, 1.32%, and 2.17% in patients with one, two, or three risk factors, respectively. We present a model for individual risk assessment that can be used easily in clinical practice.
Age Factors↗
Thrombolytic therapy.
Thrombolytic therapy may be used as either sole treatment or an adjunct to surgery in both arterial and venous disease. The age of the clot, particularly with venous thrombosis, determines the probability of successful lysis, with recent clot being highly susceptible to lytic therapy. The technique of thrombolysis is also an important determinant of the outcome, with high doses delivered directly into the clot over short time periods associated with the highest success and the lowest complication rates. Because systemic therapy increases the risk of bleeding from a remote site, techniques to concentrate the lytic agent within the clot, such as intraoperative high-dose and isolated-limb therapy, may achieve a higher success with a lower complication rate. Newer agents, which are clot specific, will be available for lytic therapy and should result in even higher success rates while minimizing systemic complications.
Fibrinolytic Agents↗