TY - JOUR
T1 - Pre-hospital fibrinolysis in the management of patients with ST elevation acute coronary syndrome
T2 - Review of the evidence, implementation and future directions
AU - Camuglia, A. C.
AU - Luis, S. A.
AU - Sengupta, A.
AU - Bett, J. H.N.
AU - Walters, D. L.
PY - 2013
Y1 - 2013
N2 - Time to reperfusion is among the strongest predictors of clinical outcome in patients who present with ST elevation acute myocardial infarction. When time to access is equivalent, primary percutaneous coronary intervention has demonstrated superior outcomes to fibrinolysis. However, where significant delays exist in accessing percutaneous intervention, fibrinolysis has an important role. The potential for fibrinolysis delivery in the pre-hospital setting means that delays to primary percutaneous intervention need to be considered from the time that the patient becomes eligible for fibrinolysis in the field. This can be particularly challenging in patients with symptom duration ofless than two hours, as some evidence suggests fibrinolysis may be particularly beneficial in this early phase. Additionally, access to primary percutaneous intervention provided by an experienced operator, in a timely manner at any time of the day or night, is not an available option in many healthcare settings. This review focuses on the current evidence and practice of pre-hospital fibrinolysis and assesses potential roles for this therapy in the future.
AB - Time to reperfusion is among the strongest predictors of clinical outcome in patients who present with ST elevation acute myocardial infarction. When time to access is equivalent, primary percutaneous coronary intervention has demonstrated superior outcomes to fibrinolysis. However, where significant delays exist in accessing percutaneous intervention, fibrinolysis has an important role. The potential for fibrinolysis delivery in the pre-hospital setting means that delays to primary percutaneous intervention need to be considered from the time that the patient becomes eligible for fibrinolysis in the field. This can be particularly challenging in patients with symptom duration ofless than two hours, as some evidence suggests fibrinolysis may be particularly beneficial in this early phase. Additionally, access to primary percutaneous intervention provided by an experienced operator, in a timely manner at any time of the day or night, is not an available option in many healthcare settings. This review focuses on the current evidence and practice of pre-hospital fibrinolysis and assesses potential roles for this therapy in the future.
KW - Acute myocardial infarction
KW - Facilitated percutaneous coronary intervention
KW - Pre-hospital fibrinolysis
KW - Pre-hospital thrombolysis
KW - Primary percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=84893458493&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84893458493&partnerID=8YFLogxK
U2 - 10.2174/1871529X1303140129155809
DO - 10.2174/1871529X1303140129155809
M3 - Review article
C2 - 24479721
AN - SCOPUS:84893458493
SN - 1871-529X
VL - 13
SP - 243
EP - 255
JO - Cardiovascular and Hematological Disorders - Drug Targets
JF - Cardiovascular and Hematological Disorders - Drug Targets
IS - 3
ER -