Elsevier

The Lancet

Volume 351, Issue 9110, 18 April 1998, Pages 1191-1196
The Lancet

Seminar
Failed coronary thrombolysis

https://doi.org/10.1016/S0140-6736(97)11198-9Get rights and content

Section snippets

Suboptimal results using current thrombolytic regimes

The efficacy of reperfusion can be assessed at several stages during the process of infarction, from restoration of flow at angiography to measures of cellular reperfusion. Recent data suggest that there is significant room for improvement in our current therapeutic approach where thrombolytics are administered with little regard as to whether they have actually produced the desired effect.

Pathogenesis of failed thrombolysis

Thrombolysis fails because of mechanisms operating at the site of the original obstruction and, secondarily, mechanisms downstream in the microvascular network.

Non-invasive detection of failed thrombolysis

The gold standard for the diagnosis of failed reperfusion is a combination of coronary angiography and myocardial contrast imaging but this is impracticable for routine clinical use. The search for a reliable non-invasive marker has generated a lot of data but few clear answers.

Management of failed thrombolysis

There are three options for the management of failed thrombolysis—namely, rescue angioplasty, an intra-aortic balloon pump, or repeat thrombolysis. There are theoretical reasons to support the use of platelet antagonists but the place of these drugs in the context of failed thrombolysis is unproven.

Conclusion

Failure of ST segment resolution after thrombolysis defines a high risk group of patients following a myocardial infarction. A post-thrombolytic ECG is already performed on most patients and probably deserves more attention than it receives. Whilst the ECG is neither very sensitive nor specific for the diagnosis of reperfusion its convenience makes it the diagnostic tool of choice, particularly when taken in conjunction with the presence of continuing pain. We need more trials to define fresh

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