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What is the role of pre-hospital thrombolysis ?

What is the role of pre-hospital thrombolysis ?

Two studies - GREAT (Grampian Region Early Administration of Thrombolysis) and EMIP (European Myocardial Infarction Project) - showed that a single bolus dose of anistreplase reduced the total mortality rate. These results suggest that early thrombolysis has greater benefit, hence the importance in many hospitals of 'door to needle time'.

What is the role of heparin with thrombolysis ?

What is the role of heparin with thrombolysis ? 

In the ISIS-3 (Lancet 1992; 339: 753-70) and G1SSI-2 (Lancet 1990; 336: 65-75) studies heparin therapy with streptokinase or anistreplase was not beneficial, and it is believed that it may even be harmful. The GUSTO trial showed that, with tPA, early intravenous heparin results in a further reduction in the mortality rate compared with that found with a combination of heparin and streptokinase.

What is the relation between thrombolysis and onset of symptoms ?

What is the relation between thrombolysis and onset of symptoms ? 

Thrombolytic therapy reduces mortality and limits infarct size. The shorter the interval between the onset of symptoms and the initiation of thrombolysis, the greater is the survival. The greatest benefit occurs if the treatment is initiated within the first three hours, when a 50% or greater reduction in mortality rate can be achieved. The magnitude of benefit declines rapidly thereafter, but a 10% mortality reduction can be achieved up to 12 hours after the onset of pain.

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