Rescue thrombolysis for failure of primary thrombolysis cannot be justified

BMJ 1999;318:261 ( 23 January )

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Rescue thrombolysis for failure of primary thrombolysis cannot be justified

The first 150 words of the full text of this article appear below.

EDITOR $---$ Drenth et al suggest a policy of repeat thrombolysis if initial thrombolysis fails,¹ but their arguments areflawed.

Firstly, they state that a routine policy of rescue angioplasty cannot be justified from a review of the literature, althoughthey fail to mention that the trial by Ellis et al showed a significantreduction in the incidence of death or severe heart failure inthe rescue angioplasty group compared with the conservative group.²

Secondly, there are far fewer published data from randomised trials comparing the use of rescue thrombolysis with conservativetreatment, yet the authors claim that these data support theircurrent practice. Only one trial randomising 37 patients has comparedrescue thrombolysis with conservative treatment, and benefit inthe rescue thrombolysis group was confined to a subgroup of patientsin whom initial thrombolysis had failed to achieve a systemiclytic state (fibrinogen concentration >1 g/l).³ Drenth et aldo not . . . [Full text of this article]

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