Interv Akut Kardiol. 2003;2(4):184-189

Prehospital thrombolysis

Stanislav Janoušek

Interní kardiologická klinika FN a LF MU v Brně

The interval from onset of symptoms to the start of treatment in acute myocardial infarction (AMI) is substantially shortened by using prehospital thrombolysis. The cumulative analysis of studies comparing prehospital and hospital thrombolysis proves statistically significant reduction of short-time and long-time mortality in prehospital thrombolysis. That profit is similar to primary percutaneous transluminal coronary angioplasty (PTCA) in comparison with hospital thrombolysis. The basic problem is record of 12leads ECG and its interpretation since thrombolysis is indicated only in the presence of ST segment elevation or recent bundle branch block. Besides training of personnel providing prehospital management is a modern alternative ECG record transmission by radio signal into specialized center of acute care (coronary care unit, intensive care unit) and their interpretation by a specialist. There are two main indications of prehospital thrombolysis. Firstly, if the transport to the hospital is longer than 60–90 min. Secondly, up to now neglected possibility, if the patients had their first contact with medical assistance during the first two hours after the onset of symptoms (Golden Hours). It is necessary to use modern thrombolytics that have shorter half-time and can be administered in the bolus (tissue plasminogen activator, reteplase, tenecteplase). Besides a shorter application time their main advantage is the possibility of combination with the following PTCA. In this respect we find basic problem limiting development of prehospital thrombolysis in the Czech Republic, which is limited financial resources since of new thrombolytics are quite expensive.

In spite of many unresolved problems the prehospital thrombolysis seems to be a hopeful strategy for the reduction of mortality in patients with AMI especially by possible combination with the following PTCA. This strategy is being verified at present in several randomized studies.

Keywords: Acute myocardial infarction, reperfusion therapy, prehospital thrombolysis.

Published: December 31, 2003  Show citation