Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.71 (Published 12 January 2002) Cite this as: BMJ 2002;324:71
All rapid responses
Dear editor:
We read very interested the wide issue published in your journal on
January, the twelfth of the current year (1). We consider the work of this
issue is very important in order to clarify several points about this
matter; which is, nowadays, one of the searching fields more necessary in
our daily clinical practise.
So, we would like to share with you some observations about the way
to show the outcomes of this extended report. Although the search-question
is clear, what is a high risk patient is not defined of an exact and clear
shape. The main outcome proposed by authors (vascular death, myocardial
infarction and stroke in high risk patients) is not answered in a fit way
in the article. We miss odds - ratiograms where these three outcomes were
shown. We also miss the standard of quality you used in this meta-
analyses. We didn’t find them in the article either the studies you refer
in it. At last, a wide show of outcomes as you present in your article
make difficult the comprehension and the general interpretation of the
analysis made by your group.
So, we consider a big effort, as you did in the making of this
article, deserves a better and clearer show of its results.
We are very pleased to contact to you, very faithfully.
(1) Antithrombotic Trialists' Collaboration. Collaborative meta-
analysis of randomised trials of antiplatelet therapy for prevention of
death, myocardial infarction, and stroke in high risk patients. BMJ 2002
12;324:71-86.
Jesus Gallego Moreno SHO of Geriatric Medicine1
Mª Dolores Rosales Ph D Geriatric Medicine2
Vicente Ruíz-García Ph MD2
Rafael Carbonell MD Ph MD3
1 Servicio de Geriatría Hospital Nuestra Señora del Perpetuo Socorro.
C/ Seminario sn 02006 ALBACETE
2 Hospital at Home Unit. Hospital La Fe. Regional Health Authority.
Valencia, Spain
VCorrespondence to:
3ENT Department, Hospital de Sagunto. Regional Health Authority.
Valencia, Spain
Correspondence to:
Jesus Gallego Moreno SHO of Geriatric Medicine
Servicio de Geriatriá Hospital Nuestra Señora del Perpetuo Socorro. C/
Seminario sn 02006 ALBACETE
Spain
email: jgallegom@hgab.insalud.es
Competing interests: No competing interests
To the Editors:
In their recently published meta-analysis(1), the Antithrombotic
Trialists’ Collaboration (ATC) authors make several statements regarding
dipyridamole plus aspirin trials that require further clarification. They
state that “the addition of dipyridamole to aspirin produced no
significant further reduction in vascular events compared with aspirin
alone”. With regard to the second European Stroke Prevention Study (ESPS-
2), “It is also plausible that these findings (which were not supported
by other studies) arose largely or wholly by the play of chance, or were
due to an insufficient daily aspirin dose or a slight antihypertensive
effect of dipyridamole.”
ESPS-2 was the only prospective, multicenter, randomized trial that
was adequately designed (2 X 2 factorial analysis) and powered to examine
the independent and additive efficacy of aspirin and dipyridamole, the
latter as the extended-release formulation. The number of patients and
vascular events (including strokes) exceeded all prior trials of
dipyridamole and aspirin. There is a 99.4% probability that the
additional 23.1% stroke risk reduction conferred by the combination of
extended-release dipyridamole plus aspirin, compared to aspirin, is not
due to the “play of chance.”2
With regard to an “insufficient dose of aspirin”, the authors remark
that “The amount of information available on the effects of prolonged
antiplatelet therapy among patients with a history of stroke or transient
ischemic attack has increased substantially since 1990. This is mainly
because of the second European stroke prevention study...” The ATC’s own
estimate of the non-fatal stroke benefit (per 1000) of antiplatelet
therapy for previous stroke/TIA patients has increased from 20% in 1994 to
25% in the current meta-analysis, largely due to the addition of data from
ESPS-2. Furthermore, the inverse trend observed between aspirin dose and
% odds reduction in the ATC meta-analysis argues against “insufficient
does of aspirin”. The trial design and quality of data should matter as
much or more than quantity of data. It is disturbing that the ATC would
question the results of a robust trial such as ESPS-2 while at the same
time accepting the expectedly discordant results of the many smaller and
less scientifically rigorous combination trials. Measurement of treatment
effect must be “unconfounded” not only within but also between trials of
antiplatelet drugs if any such meta-analysis is to be beneficial to the
practicing clinician.
(1) Antithrombotic Trialists’ Collaboration. Collaborative meta-
analysis of randomised antiplatelet therapy for prevention of death,
myocardial infarction, and stroke in high-risk patients. BMJ 2002;321:71-
86.
(2) Diener HC, Cunha L, Forbes C, Sivenius J et al. European Stroke
Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary
prevention of stroke. J Neurol Sci 1996;143:1-13
Competing interests: No competing interests
The important publication from the Antithrombotic Trialists
Collaboration meta-analysis advocates the use of antiplatelet therapy in
patients with atrial fibrillation [AF], reporting an absolute reduction in
the risk of having a serious vascular event of 22 per 1000 patients
treated for 2 years (p=0.01) [1].
It must, however, be remembered that the risk of stroke in patients
with AF is not homogenous. With the increased risk of stroke with
increasing age, and in the presence of other cardiovascular risk factors,
aspirin therapy may not be as efficacious as formal anticoagulation in
stroke prevention [2,3]. Indeed, current guidelines such as those from the
American College of Chest Physicians recommend the use of oral
anticoagulation in all AF patients > 75 years old and in all AF
patients with additional risk factors for stroke and thromboembolism (eg.
hypertension, heart failure, left ventricular impairment, rheumatic mitral
valve disease, prosthetic valve, prior thromboembolism, etc) [4].
For patients at ‘moderate risk’ for stroke (for example, age 65-75
years, ischaemic heart disease and diabetes), if more than one risk factor
is present, these patients should also be started on warfarin unless there
are any contraindications. Aspirin use is therefore only of potential use
as adequate thromboprophylaxis in 'low risk' AF patients - for those aged
<_65 years="years" with="with" no="no" additional="additional" risk="risk" factors="factors" _-="_-" or="or" in="in" those="those" patients="patients" whom="whom" warfarin="warfarin" therapy="therapy" is="is" contraindicated.="contraindicated." p="p"/> Furthermore, in this meta-analysis [1] the 24% odds reduction in
serious vascular events seen with antiplatelet therapy for AF is the
reduction one would expect to see for aspirin in patients with vascular
disease or other atherosclerotic risk factors, which commonly co-exist in
the patients with AF. Thus, the benefit one sees with aspirin in reducing
vascular events in AF may simply relate to the beneficial effects in
vascular disease. It should also be noted that in Figure 4 of the
metaanalysis, the 95% confidence intervals for the 24% odds reduction in
vascular events overlap with zero, highlighting the possibility that
patients with AF could potentially gain no benefit on antiplatelet
therapy. Indeed, for patients with acute stroke with AF, the benefit of
aspirin in the acute setting is considerably less than that for stroke
patients who were in sinus rhythm at presentation [5].
We accept that the recent metaanalysis by Taylor et al [6] suggested
no advantage of warfarin over aspirin for death and stroke mortality, but
the associated correspondence in the journal highlights many issues
regarding that analysis [see
http://bmj.com/cgi/content/full/322/7282/321?view=full&pmid=11159653#res....
We would therefore suggest that antiplatelet therapy is not protective in
all cases of AF and would advocate a strategy of careful risk
stratification and assessment of the risk-benefit ratio for individual
patients.
BETHAN FREESTONE [Research Fellow in Cardiology]
GREGORY YH LIP [Professor of Cardiovascular Medicine]
Haemostasis, Thrombosis and Vascular Biology Unit,
University Department of Medicine,
City Hospital, Birmingham B18 7QH, UK
REFERENCES
1.Antithrombotic Trialists’ Collaboration. Collaborative meta-
analysis of randomised trials of antiplatelet therapy for prevention of
death, myocardial infarction, and stroke in high risk patients. BMJ 2001;
324: 71-86
2.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent
risk factor for stroke: The Framingham Study. Stroke 1991; 22: 983-988
3.Risk factors for stroke and efficacy of anti thrombotic therapy in
atrial fibrillation. Analysis of pooled data from five randomised control
trials. Arch Intern Med 1994; 154: 1449-57
4.Albers GW, Dalen JE, Laupacis A, Manning WJ, Peterson P, Singer DE.
Antithrombotic therapy in atrial fibrillation. Chest 2001; 119:194S-206S
5.Lip GYH, Beevers DG. Effect of aspirin in patients with AF and acute
stroke. Lancet 1997; 350: 442-3
6.Taylor FC, Cohen H, Ebrahim S. Systematic review of long term
anticoagulation or antiplatelet treatment in patients with non-rheumatic
atrial fibrillation. BMJ. 2001;322(7282):321-6.
Competing interests: No competing interests
We congratulate the British Medical Journal upon the paper entitled
“Collaborative meta-analysis of randomised trials of antiplatelet therapy
for prevention of death, myocardial infarction, and stroke in high risk
patients” (BMJ 2002; 12; 324 (7329): 71-86).
The work clearly explains “why” it is important to perform an antiplatelet
therapy in these patients and we agree with Authors who recommend
continuous administration of low-dose aspirin, because of its inhibition
of platelet aggregability. However, we suggest it could be of great
important also to state “when” this therapy should be performed, as
aspirin treatment is more successful when it is taken in the morning.
In fact, in 1982, we documented in healthy male subjects a circadian
variation of epinephrine and collagen-induced platelet aggregability,
using microscopic rhythmometric analysis (1). Moreover, in 1987, Tofler et
al. confirmed this results using a macroscopic analysis (chronograms) of
platelet responsiveness to adenosine diphosphate and epinephrine (2-3) and
underlined a temporal association between increased plated aggregability
at morning and increased frequency of sudden cardiac death, as also showed
in later studies (4).
In summary, low-dose aspirin administration in the early morning hours may
represent an effective therapy in the primary prevention of myocardial
infarction and morning sudden cardiac death.
Sensi S., Guagnano M.T., Marinopiccoli M., Davì G.
Department of Internal Medicine and Ageing – Chieti University - Italy
References
1) Circadian variations of adrenalin and collagen induced platelets
aggregation in male
subjects. G Nubile, L D'Alonzo, A Consoli, G Moutzouridis, S Sensi.
Boll Soc It Biol Sper 1982; LVIII (15): 947.
2) Concurrent morning increase in platelet aggregability and the risk of
myocardial
infarction and sudden cardiac death. Tofler GH, Brezinski D, Schafer AI,
Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Muller
JE. N Engl J Med 1987; 316: 1514.
3) Circadian variation in the frequency of sudden cardiac death. Muller
JE, Ludmer PL,
Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH. Circulation
1987; 75: 131.
4) Morning sudden cardiac death. Guagnano MT, Davì G, Sensi S. Int J Immunopathol Pharmacol 2000; 13 (1): 55.
Competing interests: No competing interests
Antithrombotic trialists - Have they shortchanged aspirin with extended-release dipyridamole for str
The Antithrombotic Trialists conclude that adding
dipyridamole to aspirin produces "no further reduction in
vascular events." However, the second European Stroke
Prevention Study (ESPS-2) showed that combination treatment
with aspirin and extended-release dipyridamole was twice as
effective as aspirin alone for prevention of recurrent
stroke, leading to a 37% decrease.(1)
ESPS-2 was a very large (6,600 patients), well-controlled,
well-designed, well executed modern study. The other trials
included by the Trialists in their meta-analysis were much
older and smaller with, understandably, less robust and
meaningful results. In fact, the total number of patients
randomized in all 24 other trials of dypiridamole and
aspirin were less (36%) than the number of patients
entered in ESPS-2 (n=6602). ESPS-2 also used an
extended-release formulation of dipyridamole that is not
pH-dependent as to dissolution and from which
bioavailability of the drug can be assured, unlike the
formulation used in older trials. As the authors state.
dipyridamole is not purely an antiplatelet agent, like
aspirin. The effect of dipyridamole is at least partly
through interaction with the vessel wall, and the drug must
be well-absorbed to provide optimal benefit. The older
trials used smaller doses of dipyridamole than ESPS-2 and
were too small to provide definitive results. In the
authors current analysis of trials in patients with stroke
or transient ischemic attacks, the benefit from antiplatelet
agents in preventing non-fatal stroke was clearly magnified
(25 (SD 5) per 1000 vs 20 (SD 6) per 1000) from their last
analysis in 1994, largely due to the addtion of the data
from ESPS-2.
Nonetheless, even when the ESPS-2 data are aggregated with
previous studies combination therapy with aspirin and
dipyridamole significantly reduces the risk of recurrent
stroke alone by 23% over aspirin alone.(2) These are
important results for those looking for ways to manage
recurrent stroke, especially now that the WARSS study has
shown that warfarin is no more effective, and possibly more
risky, than aspirin.(3)
Louis R Caplan MD
Professor Neurology Harvard Medical School
Chief Cerebrovascular Disease
Beth Israel Deaconess Medical Center
Boston
Lcaplan@caregroup.harvard.edu
Pierre Fayad MD
Reynolds Centennial Professor and Chair
Dept Neurology
University of Nebraska
H Christoph Diener
Professor and Chair Neurology
University of Essen, Germany
References:
1. Diener HC, Cunha L, Forbes C, et al. European Stroke
Prevention Study. 2. Dipyridamole and acetylsalicylic acid
in the secondary prevention of stroke. J Neurol Sci.
1996;143:1-13.
2. Wilterdink JL, Easton D. Dipyridamole plus aspirin in
cerebrovascular disease. Arch Neurol. 1999;56:1087-92.
3. Mohr JP, Thompson JLP, Lazar RM, et al. A comparison of
warfarin and aspirin for the prevention of recurrent
ischemic
Competing interests: No competing interests
Not even 4th place for the risk of antiplatelet drugs?
Editor - The Antithrombotic Trialists' Collaboration has done an
excellent job in presenting in their 15 page
article the benefits of long and short term antiplatelet therapy[1]; but
to detail in just two short paragraphs their side effects seems to us an
unjustified and summary dismissal.
For example, the absolute reduction of 10.1 serious vascular events
(excluding haemorrhagic deaths) per 1000
patients receiving antiplatelet drugs over 3 weeks for the treatment of
acute stroke, comes at a costly 3.9 fatal
and non-fatal major bleeds per 1000 patients. For every 2 to 3 patients in
whom a serious vascular event is prevented, one will be subject to an
iatrogenic bleed which carries a surely significant 21% mortality.
Incidentally, acute strokes make up the largest bulk of patients by far in
the authors’ meta-analysis and come 2nd in the ‘What this study adds’
section but there is no mention at all of side effects in their 4 bullet-
point summary. The article would surely be better balanced if more prime
real estate was dedicated to the side effects of antiplatelet drugs.
Antiplatelet therapy has a statistical edge in this large albeit
inhomogeneous population of patients, but it is
difficult to translate such benefits to individual patients, many of whom
will have above average risk of
bleeding as in those on other NSAIDs (more than two times the risk[2]), or
those infected with H. pylori (odds
ratio 1.81[3]) which will put the probability of bleeding in these
patients on a par with the probability of
preventing serious vascular events.
Small probabilities of risk or benefit may be better appreciated on a
logarithmic scale[4]. Most would trade
benefit in 100 patients for harm in 1, but not all would trade benefit in
100 for harm in 10. For antiplatelet drugs
in acute stroke, balancing benefit in 10/1000 patients against harm in
3/1000 seems almost too close to call.
Doctors treating individual patients need to move the debate back to
consider the diversity of the patients that
we serve and their personal choice with regard to risk and benefit. We now
know the odds but need guidance as to whether to express the odds to our
patients and if so how to present these very difficult numerical concepts.
Any patient starting antiplatelet drugs and indeed any preventive drugs is
taking a gamble. The overall
incidence of benefit or harm are small and the odds are indeed in favour
of benefit but can we assume that all
our patients are gamblers?
WA Yap, 5th year Medical Student, University of Newcastle upon Tyne
PN Trewby, MD FRCP, Consultant Physician
Darlington Memorial Hospital,
Darlington,
Co Durham DL3 6HX.
E-mail: peter.trewby@smtp.sdhc-tr.northy.nhs.uk
References
1. Antithrombotic Trialists' Collaboration. Collaborative meta-
analysis of randomised trials of antiplatelet therapy for prevention of
death, myocardial infarction and stroke in high risk patients. BMJ 2002;
324: 71-86
2. Sorensen HT, et al. Risk of upper gastrointestinal bleeding
associated with use of low-dose aspirin. Am J of Gastroenterology 2000;
95(9):2218-24
3. Hawkey CJ. Risk of ulcer bleeding in patients infected with
Helicobacter pylori taking non-steroidal anti-inflammatory drugs. Gut
2000; 46(3):310-1
4. Paling J. Up to your armpits in alligators. How to sort out what
risks are worth worrying about! 1997 ISBN 0-9642236-6
Competing interests: No competing interests
To the Editor:
The updated meta-analyses by the Antithrombotic Trialists'
Collaboration (ATC) confirms the benefits of aspirin in reducing non-fatal
myocardial infarction, non-fatal stroke, vascular deaths, and total
mortality in patients at high risk of vascular events.1 High risk was
defined as patients with previous "occlusive events" or predisposing
conditions (e.g. diabetes) that led to risks of suffering a vascular event
that were greater than 3% per year.
Based on these findings, the authors recommended aspirin for patients
with high cardiovascular risks and low or average gastrointestinal
bleeding risks. In their discussion, the authors also recommended aspirin
for patients at intermediate risk of vascular events (annual risk of 2-
3%), including those with peripheral vascular disease, stable angina, or
atrial fibrillation. They then concluded by stating that: "For most
healthy individuals, however, for whom the risk of a vascular event is
likely to be substantially less than 1% per year, daily aspirin may well
be inappropriate."
We recently performed a systematic review and meta-analysis of the
effect of aspirin in adults with no previous history of cardiovascular
events for the US Preventive Services Task Force (USPSTF). 2 Based on the
results of 5 large trials that evaluated the use of aspirin for patients
without cardiovascular disease, we concluded that aspirin reduced the risk
of non-fatal myocardial infarction and coronary heart disease deaths by
28%. Aspirin had little effect on thrombotic strokes or all-cause
mortality over the 3-7 year duration of the trials. The risk of coronary
heart disease of patients in the five trials ranged from 0.36 - 1.24% per
year, well below the high-risk patients studied in the ATC review. We
found that the harms of aspirin included increased risks of hemorrhagic
stroke and gastrointestinal bleeding that were similar to the levels found
in the high-risk patient trials.
We concluded that the number of potential reductions in coronary
heart disease events exceeded the number of potential precipitated adverse
bleeding events when patients have a 1% or greater annual risk of coronary
heart disease events. Numbers of adverse effects approached the numbers of
beneficial effects when the annual risk of coronary heart disease was 0.2%
or less. The balance of beneficial and adverse effects was closer for
those with risks between 0.2 - 1.0% per year. Providers and patients can
easily measure such risks by using any one of several cardiovascular risk
calculators available on the web, including our own site (www.med-
decisions.com). We strongly recommend that providers and patients
incorporate both risk and patient values about those risks into their
decisions regarding whether or not to use aspirin.
Sincerely,
Michael Pignone, MD, MPH
RTI-UNC Evidence-based Practice Center, Chapel Hill, NC
Cynthia Mulrow, MD, MSc
University of Texas Health Science Center, San Antonio, TX
References
1. Antithrombotic Trialists' Collaboration .Collaborative meta-
analysis of randomised trials of antiplatelet therapy for prevention of
death, myocardial infarction, and stroke in high risk patients. BMJ 2002;
324: 71-86.
2. Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the Primary
Prevention of Cardiovascular Events: A Summary of the Evidence for the
U.S. Preventive Services Task Force. Annals of Internal Medicine
2002;136:161-172.
Competing interests: No competing interests
EDITOR: The Antithrombotic Trialist’ Collaboration have with their
recent meta-analysis emphasised the importance of aspirin use in primary
and secondary prevention of cardiovascular disease (1). In their
discussion they raise the point that use of aspirin in patients with
diabetes is limited, despite the evidence that Aspirin therapy has been
shown to reduce vascular disease in this patient group. This has also been
reported in a recent study by Rolka et al (2).
We performed a clinical audit to assess the use of aspirin in diabetes and
to identify methods with which to increase its use according to ADA
recommendations (3). The notes of 100 consecutive patients having attended
the diabetes out-patient clinic over a 2-week period in June 2001 were
randomly selected and information on risk factors and aspirin use was
collected. Findings were presented at the unit meeting and reiterated
weekly, summarised in a memo and guidelines displayed in all clinic rooms.
Aspirin use was re-audited 6 months later in another random sample
(n=100).
At the first audit Aspirin was prescribed in 27% and 18% of patients with
an indication for primary prevention [type 1 (n=8) and type 2 (n=68)
respectively] and in all patients (100%) where indicated for secondary
prevention [type 1 (n=2) and type 2 (n=16)]. At re-audit prescription of
aspirin had increased to 60% and 62% of patients with an indication for
primary prevention [type 1 (n=10) and type 2 (n=61) respectively] and
remained at 100% where indicated for secondary prevention [type 1 (n=5)
and type 2 (n=10)].
We were thus able to demonstrate that the use of aspirin in clinical
practice for prevention of vascular disease in diabetes can be increased
significantly by simple audit measures. However, we are aware of the need
to reinforce the message that patients with diabetes and one or more
additional risk factors for vascular disease (previous vascular disease,
family history of myocardial infarction or stroke, smoking, obesity,
hypertension, micro- or macroalbuminuria or dyslipidaemia) benefit from
treatment with low dose aspirin.
Competing interest: none
1. Collaborative meta-analysis of randomised trials of antiplatelet
therapy for prevention of death, myocardial infarction, and stroke in high
risk patients. BMJ 2002; 324: 71-86
2. Rolka,D.B.; Fagot-Campagna,A.; Narayan,K.M. Aspirin use among adults
with diabetes: estimates from the Third National Health and Nutrition
Examination Survey. Diabetes Care 2001; 24, 197-201,
3. ADA: Aspirin therapy in diabetes (Position statement). Diabetes Care
2000; 23 (suppl.1) S61-S62,
Competing interests: No competing interests
Today's issue devotes 16 pages to an article (1) which contains no
original data and which may not be accurate due to several potential
sources of bias (2). It looks like space in the BMJ's pages is not quite
at the premium that we are constantly told.
Perhaps future meta-analyses could be limited to a maximum of 1 printed
page and a URL reference for the (small) number of people who actually
want to read it.
1. Antithrombotic Trialists' Collaboration. Collaborative meta-
analysis of randomised trials of antiplatelet therapy for prevention of
death, myocardial infarction, and stroke in high risk patients. BMJ 2002;
324: 71-86
2. Cleland JGF. Preventing atherosclerotic events with aspirin. BMJ 2002;
324: 103-5
Competing interests: No competing interests
Gender difference in the results of thrombolytic therapy in acute myocardial infarction
Gender difference in the results of thrombolytic therapy in acute
myocardial infarction
Authors : Prof. A.Barzigar ; Dr. Manzar Hussain Akbar ;
Heshmat cardiovascular research center , Guilan University of Medical
Sciences
Background :
Heparin and streptokinaseare widely used as a routine thrombolytic therapy
in Hyperacute stage of myocardial infarction acute myocardial infarction
(AMI) .
Studies such as ISIS-1 and ISIS-2 have reported a decrease in mortality.
Thrombolysis carries some complications too.We compared the efficacy
complications and mortality rate of thrombolytic therapy in 719 males with
those in 293 females.
Method:
1012 consecutive cases of hyper acute myocardial infarction admitted
between 1999 up to 2001 were included.We compared the immediate clinical
effects complications and mortality rate through this retrospective
study.
Data of variables were extractedfrom hospital case record and analyzed by
standard research methodology . Chi 2 test was used for comparison.
Result:
Age groups and major risk factors were matched in both groups.
Overall in hospital mortality in male was 5.4% in comparison to 17.7% in
female.
Immediate effect as angina relief with in 90 minutes was found in 78.4% of
males vs. in 67.5% in females( p=0.004).
Rapid rise of CPK was found in 74.7% of males versus 68.7% in females.
Normalization of ST segment in electrocardiogram was found in 27.9% of
males vs. 23.3% in females. Drug allergy was found 3.7% in men vs 2.7% in
women.
Intracranial hemorrhage was found in 0.4% of males vs. 1.4% in females.
Internal bleeding was found in 2.7% of males vs. 5.5% in females( P=0.03
).
Arterial hypotension was found in 22.3% of males vs. 30.5% in females (
P=0.008 ).
Congestive heart failure was found in 5.8% of males vs. 9.4% in females (
P=0.05 ).
Cardiogenic shock was found in 6.1% of males vs. 13.4% in females (
P<_0.001 _.="_." p="p"/>Sudden death was witnessed in 7.6% of males vs. 17.7% in females.
CPR was successful in 28.3% in males vs. 6.1% in females ( P=0.003 ).
Conclusion: This study revealed the significant difference in the
effects and complications of thrombolytic therapy between male and
female,and suggests that male patients of acute myocardial infarction got
more benefits than female.
Angina relief within 90 minutes was achieved more frequently in men.
Except the allergic reaction, all the side effects and complications were
more in women than men. Incidence of witnessed cardiac arrest and CPR
applied was higher in males than females leading to a higher mortality
rate among female patients receiving streptokinase in our center.
Competing interests:
None declared
Competing interests: No competing interests