RESUMO
We feel that while our patient succumbed to complications of his extensive anterior myocardial infarction, the devastating renal, subcapsular, and retroperitoneal hemorrhage as well as the cerebral hemorrhage certainly appeared to hasten his demise. From this experience, we now consider recent renal lithotripsy to be a major contraindication to the use of thrombolytic agents. Logically, the time frame for omitting thrombolytic therapy following renal lithotripsy should be similar to that of other major surgical procedures, approximately four to six weeks.
Assuntos
Hemorragia/etiologia , Nefropatias/etiologia , Litotripsia/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Hemorragia/diagnóstico , Humanos , Cálculos Renais/terapia , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológicoRESUMO
To determine whether intravenous streptokinase can be delivered safely and effectively in a community hospital without acute angiography, we treated 120 patients with intravenous infusion of 1.5 million units of streptokinase shortly after arrival in the emergency room. Average time from onset of pain to treatment was 2.7 hours. Therapy was well tolerated without significant complication. Reperfusion was clinically suspected in 78% of patients. Coronary angiography was done at referral hospitals in 94% of the surviving patients two to ten days after treatment. The infarcted vessel was patent in 74% of these patients. Of these, coronary angioplasty was performed in 36%, and 32% had bypass grafting. We conclude that intravenous streptokinase can be safely and effectively used in community hospitals without acute angiography in carefully selected patients with acute myocardial infarction.
