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Time as an adjunctive agent to thrombolytic therapy

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Abstract

Thrombolytic therapy has dramatically reduced mortality following acute myocardial infarction (MI) with the major effect coming fromearly 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 considertime 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 reperfusion. Efforts to reduce each of these components will lead to additive benefits in improving time to reperfusion and survival of patients with acute MI.

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Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

    Christopher P. Cannon, Elliott M. Antman & Eugene Braunwald

  2. Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts

    Ron Walls

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  1. Christopher P. Cannon
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  2. Elliott M. Antman
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  3. Ron Walls
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  4. Eugene Braunwald
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Cannon, C.P., Antman, E.M., Walls, R. et al. Time as an adjunctive agent to thrombolytic therapy. J Thromb Thrombol 1, 27–33 (1994). https://doi.org/10.1007/BF01061992

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