Thrombolytic Drugs May Increase Mortality in Elderly

The study was reported in the March 11, 2002, issue of Archives of Internal Medicine.

The researchers examined the records of 2,659 patients with heart attack admitted to community hospitals from 1992-1996. Of these, 719 were eligible for thrombolytic therapy according to the guidelines. These rely on the time from symptom onset (under 12 hours), electrocardiogram readings, and the absence of contraindications such as trauma, bleeding, or extremely high blood pressure. About 63% of eligible patients and 14% of ineligible patients in the study received the drugs.

Among the eligible patients 80-90 years old, those who received the drugs had an estimated 40% greater risk of death in the hospital compared with patients who did not receive the drug. For all ineligible patients, the drug increased the risk of death regardless of age. For the entire group as a whole (over 65), the death risk linked to thrombolytic therapy rose 4% for each year of age. The researchers note that elderly patients are more likely to have contraindications, to have increased risk for bleeding and stroke, and tend to experience longer delays in arriving at the hospital. An earlier study from Johns Hopkins University (Baltimore, MD, USA) revealed similar results: patients over 75 who received thrombolytic drugs were nearly 40% more likely to die within 30 days than patients who did not receive the drugs.

"The oldest patients, even those without contraindications to therapy, experienced an excess risk of mortality compared with the untreated patients,” the authors write. "Findings of this study suggest a need to reassess our approach to the use of thrombolytic therapy in the treatment of heart attack patients older than 75.”




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