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Circulation, Vol 88, 2556-2564, Copyright © 1993 by American Heart Association
ML Simoons and AE Arnold
BACKGROUND. In contrast with current standard regimens, it seems more
appropriate to tailor thrombolytic therapy to individual patient
characteristics. A proposed model for such tailored therapy is based on
individual assessment of benefits and risks of thrombolytic therapy, taking
into account the response of individual patients to the therapy given.
METHODS AND RESULTS. Potential benefits of thrombolysis in individual
patients can be predicted by use of demographic patient characteristics
(age, sex, history of previous infarction) together with indicators of the
ischemic area at risk (total ST segment deviation) and treatment delay.
Using these parameters, the number of "lives saved" by thrombolytic therapy
for specific patient characteristics can be estimated. Similarly, the risk
of intracranial hemorrhage during thrombolytic therapy can be estimated
from the patient's age, blood pressure at admission, and body weight.
Depending on benefit/risk estimates, a choice can be made between regimens
with high, medium, or modest thrombolytic efficacy. Continuous multilead
ECG ischemia monitoring and rapid assays of myocardial proteins in serum
can be used to assess the occurrence or absence of reperfusion and to
detect signs of reocclusion. Such data help to decide whether thrombolytic
therapy should be continued or intensified or might be discontinued in
individual patients before the total standard dose has been administered.
Such tailored reduction of the total thrombolytic dose will reduce the risk
for bleeding complications in some of the patients. CONCLUSIONS. The
concept of tailoring thrombolytic therapy and the models presented for
benefit/risk assessment should be tested in clinical studies and may
subsequently help the physician to select the optimal approach in
individual patients.
ARTICLES
Tailored thrombolytic therapy. A perspective
Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
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