Clinical determinants of severe bleeding complications in patients with acute myocardial infarction treated with thrombolytic therapy

The aim of the study was to determine the frequency of bleeding complications in a clinical setting, and to clarify the practise in laboratory monitoring of haemostasis (TT%, APTT, HCR) in patients with acute myocardial infarction who are treated with fibrinolytics. In this clinical, retrospective series we included randomly 301 patients who were treated during the years 2000–2003 due to acute myocardial infarction in the Helsinki University Central Hospital. Two hundred and forty (80%) of the patients were treated with a thrombolytic therapy. Six (3%) patients received thrombolytic therapy despite them having an absolute contraindication, and 75 (31%) received it while having a relative contraindication. The incidence of cerebral bleeding during the first 48 hours was unexpectedly high (2.5%). The incidences of bleeding complications are presented in Table 1. The parameters of haemostasis could not predict bleeding complications in our study, probably due to low rate of measurements prior to fibrinolytic therapy. It is therefore important to strictly follow the guidelines of thrombolytic therapy in patients with acute ST-elevation myocardial infarction. Routines for laboratory monitoring of haemostatic variables are to be implemented to improve safety and early detection of bleeding complications.

Table 1