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Clot Busters Do Not Help Older Seniors

Cheryl A. Thompson

Patients older than 75 years likely do not benefit from receiving thrombolytic therapy after a myocardial infarction (MI), researchers reported in the May 16 issue of Circulation.

Eighteen percent of patients ages 76 to 86 who received intravenous streptokinase or alteplase in addition to heparin and aspirin after an MI died within 30 days. Without thrombolytic therapy, however, only 15.4 percent of same-age patients died within 30 days. Women, but not men, who received thrombolytic therapy had a higher risk of death within the first 30 days.

The study used data from a national database compiled by the Health Care Financing Administration. All patients selected for the study were Medicare fee-for-service beneficiaries who had been discharged from an acute care hospital in 1994 or 1995 with a primary diagnosis of MI and had arrived at the hospital within 12 hours of the first symptoms.

The researchers excluded patients who had been transferred from another hospital or admitted from a nursing or retirement home, patients whose MI occurred after admission to the hospital, and patients at hospitals that could perform angioplasty. Even with these exclusions, the researchers noted, the selection of patients could have been biased, compromising the applicability of the study’s findings.

Besides the 2,673 patients ages 76 to 86, the researchers studied 5,191 patients ages 65 to 75. In the first 30 days after an MI, 9.8 percent of the younger seniors who did not receive thrombolytic therapy died, compared with only 6.8 percent of the group who received the therapy. These results agree with the findings of a meta-analysis of randomized trials of thrombolytic therapy published in 1994 in Lancet.

Guidelines from the American Heart Association and the American College of Cardiology on the treatment of MI recommend the use of thrombolytic agents in patients older than 75 years who seek care within 12 hours of symptom onset. This recommendation comes with a caveat to clinicians noting that not all the supportive evidence favored the treatment.

The authors of the article in Circulation did not dispute the guidelines but called for randomized and observational studies of thrombolytic therapy in older seniors with MI.