Thrombolysis in patients with diabetes

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6971.3 (Published 07 January 1995) Cite this as: BMJ 1995;310:3
  1. Helen Ward,
  2. John S Yudkin
  1. Senior house officer in medicine Professor of medicine Department of Medicine, Whittington Hospital, London N19 5HT

    Withholding treatment is probably mistaken: patients should be given a choice

    Any junior doctor treating a patient with diabetes mellitus and an acute myocardial infarction faces a dilemma. Lists of cautions and contraindications for thrombolytic treatment usually include diabetic retinopathy. The reasonable fear of precipitating a vitreous or retinal haemorrhage helps to explain why fewer diabetic than non-diabetic patients are given thrombolysis.1 2 Funduscopy is not, however, easy in a brightly lit receiving room after the administration of opiates. Even after mydriatic drops are given it may not be possible definitely to exclude changes in the eye. The next hurdle to face after making the decision to give thrombolysis—or not—is to justify one's actions on the post-take ward round.

    The British National Formulary states that diabetic retinopathy is a contraindication to thrombolysis, …

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