Thrombolytics for heart attack and unstable angina

These drugs dissolve or break up blood clots that are blocking blood flow through a coronary artery. Clots cause most heart attacks.

These drugs work best for a heart attack if they are given within 3 hours of a heart attack.

Thrombolytics are not an option for everyone. Conditions that make taking thrombolytics too risky include:

• A recent major injury.
• A stroke.
• A bleeding ulcer.
• A brain tumor.
• Recent surgery.
• A suspected tear in the aorta.
• A bleeding disorder.
• Very high or very low blood pressure.

Other conditions taken into consideration before using thrombolytics include your age and weight.

It has been well established that thrombolytics save lives. Studies have shown an 18% reduction in death when thrombolytics are used after a heart attack.¹

Side effects of thrombolytics may include the following:

• Severe bleeding can occur, especially in the brain (intracranial hemorrhage), which can be life-threatening. Risk may be higher if you are advanced in age, have low body weight, or have increased blood pressure.
• Streptokinase can cause fever, irregular heartbeats, low blood pressure, and an allergic reaction.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

These drugs are not an option for everyone who has had a heart attack. The decision to use a thrombolytic drug is made based upon how severe your heart attack is, how long you have had your symptoms, and what other medical problems you have. Thrombolytics can increase a person's risk of serious complications (risks greater than the heart attack itself). They work best if they are used very early during a heart attack. Inappropriate use of thrombolytics may expose a person to the risks associated with these drugs without any potential benefit.

Emergency angioplasty with or without stenting is typically the first choice of treatment if it is available and the person can tolerate it. When performed in a hospital that has extensive experience in the procedure, angioplasty proved to save an extra 2 lives in every 100 people treated with angioplasty instead of thrombolytic therapy.²

A heart attack must be confirmed using an electrocardiogram and muscle protein tests, such as troponin, before thrombolytics are used.

Thrombolytics are also used to treat blood clots that cause strokes.

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Citations

1. American College of Cardiology (ACC) and American Heart Association (AHA) (2004). ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction. Report of the ACC/AHA Task Force on Practice Guidelines. Available online: http://www.acc.org/clinical/topic/topic.htm#guidelines.

2. Aversano T, et al. (2002). Thrombolytic therapy vs. primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery. JAMA, 287(15): 1943–1951.