PREHOSPITAL FIBRINOLYTIC THERAPY

Prehospital Fibrinolytic Therapy



Prehospital Fibrinolytic (Thrombolytic) Therapy

Introduction

Treatment of acute myocardial infarction (AMI) continues to undergo significant changes. Quality practice should be based on tangible evidence obtained in a properly conducted clinical trials. Taking into account that in recent years there have been many studies of new treatments and diagnostic tests, Society of Cardiology has decided to revise the guidelines for treatment of acute myocardial infarction, and appointed a working group on the issue. It must be recognized that even in the case of perfect conducting clinical studies of their results are open to interpretation, and choice of treatment options may be limited. In fact, all the more important aspect in deciding on therapeutic strategies is the ratio of cost and effectiveness.

The Nature of the Condition or Treatment

Acute myocardial infarction (AMI) is a leading cause of death in this century. The beginning of the 80's marked a definite boundary between the classical treatment of myocardial infarction and thrombolytic therapy or modern era. Thrombolysis or fibrinolysis is a real revolution in the history of medicine. This procedure, performed in the first hours after the myocardial infarction, mortality has been reduced by up to 50% compared to patients treated by conventional methods. Intravenous fibrinolytic therapyis used widely in the treatment of ST-elevation acute myocardial infarction. Advances in this therapeutic modality during the past 5 years include new third-generation fibrinolytic agents and creative strategies to enhance administration and efficacy of fibrinolytic therapy (Medscpae, 2007). Several of the new agents allow for single- or double-bolus injection. A number of ongoing large randomized trials are attempting to determine whether the combination of fibrinolytic therapy with low molecular-weight heparin or a glycoprotein antagonist enhances coronary reperfusion and reduces mortality and late reclusion. One large prospective trial is investigating the potential benefit of prehospital administration of fibrinolytic therapy.

Prehospital Treatment or Significance

The prehospital thrombolysis of acute myocardial infarction is an established treatment strategy for the treatment of acute ST-segment elevation myocardial infarction (Medscpae, 2007). The primary PTCA may be in the right time window of prehospital Thrombolysis superior to [3], but not always at all times and available anywhere. It is, therefore, not be taken for of course, that all treatment options (medication, catheter-interventional and surgical) together for loading successful treatment result (Lyden, 2005). Prehospital fibrinolytic therapy, also called Prehospital fibrinolysis is a therapeutic procedure consisting in the administration to a patient with acute coronary syndrome medicines, before taking the patient to the hospital, usually in the patient's home, or in an ambulance rescue, by a qualified team of medical emergency (Bates, 2008). The principle of thrombolytic therapy, the patient receives an intravenous drug that dissolves blood clots in the coronary artery so that blood flow in the artery restored. At the same time be given additional treatment with drugs that act on platelets (aspirin) and coagulation (heparin) to prevent reclusion.

In some countries prehospital fibrinolytic therapy is done, which shortens the initiation of thrombolysis within an hour on ...