Featured Research

from universities, journals, and other organizations

Clot-Busting Drugs Linked To Increased Mortality In Elderly

Date:
March 11, 2002
Source:
Harvard Medical School
Summary:
More and more heart attack patients are getting thrombolytic therapy as a result of studies showing the clot-busting drugs can reduce the risk of dying. But a new study led by Harvard Medical School researchers adds to the growing body of evidence that thrombolytic drugs may increase the overall risk of death for some patients, particularly the oldest and those with certain medical conditions or histories.

Boston, MA -- More and more heart attack patients are getting thrombolytic therapy as a result of studies showing the clot-busting drugs can reduce the risk of dying. But a new study led by Harvard Medical School researchers adds to the growing body of evidence that thrombolytic drugs may increase the overall risk of death for some patients, particularly the oldest and those with certain medical conditions or histories. The results suggest that national guidelines on the use of these drugsæsuch as streptokinase and tissue plasminogen activator (t-PA)æshould be applied with greater selectivity, and possibly revised, to maximize benefit and minimize risk due to bleeding or stroke, said lead author Stephen Soumerai, professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care. Co-authors of the article, which appears in the March 11 Archives of Internal Medicine, include two of Soumerai’s colleagues in the HMS/HPHC Department of Ambulatory Care and Prevention, assistant professor Thomas McLaughlin and associate professor Dennis Ross-Degnan, along with collaborators from Boston University School of Public Health and the University of Massachusetts Medical School. The study was funded by the National Institute on Aging of the National Institutes of Health.

Related Articles


The researchers examined records of 2,659 patients with acute myocardial infarction admitted to 37 Minnesota community hospitals from 1992 to 1996. Of this group, 719 patients were eligible for thrombolytic therapy according to the guidelines, which rely on time from symptom onset (under 12 hours), electrocardiograph readings, and absence of contraindications such as trauma, bleeding, or extremely high blood pressure.

In the study, about 63 percent of eligible patients and 14 percent of ineligible patients received the drugs. Thrombolytic therapy was associated with reduced mortality among eligible patients younger than 80 years, but with increased mortality in older patients. Among eligible patients 80 to 90 years old, those who got the drugs had an estimated 40 percent greater risk of death in the hospital compared with patients who did not receive the drugs. For ineligible patients, use of the drugs increased the risk of death regardless of age. For the entire patient group (age 65-plus), the risk of death associated with thrombolytic therapy rose 4 percent for each year of age.

There are several reasons why elderly patients may not share the benefits of thrombolytic therapy seen in younger patients. The elderly are more likely to have contraindications, their risks for bleeding and stroke are markedly increased, and they tend to experience longer delays between symptom onset and hospitalization that substantially reduce the drugs’ effect on survival. Thirty-eight percent of the patients in the study who got thrombolytic therapy had contraindications. This suggests that heart attack patients in typical practice settings are not as carefully selected for thrombolytic therapy as patients in trials areæa problem that commonly frustrates the smooth transition of treatments from clinical trials into community practice.

"The oldest patients, even those without contraindications to therapy, experienced an excess risk of mortality compared with untreated patients," the authors write. "Findings of this study suggest a need to re-assess our approach to the use of thrombolytic therapy in the treatment of acute myocardial infarction patients older than 75 years."

A study from John Hopkins University, published in the May 16, 2000 Circulation, produced similar results: patients over age 75 who got thrombolytic drugs were nearly 40 percent more likely to die within 30 days than patients not receiving the drugs.

"Many doctors have been hesitant to prescribe thrombolytic therapy for the oldest patients with myocardial infarction, despite guidelines that strongly promote the therapy for patients of all ages," Soumerai said. "Our findings, along with those of the earlier study, really seem to justify their concerns." The authors recommend that alternative treatments for elderly patients, such as primary coronary angioplasty, be further evaluated.


Story Source:

The above story is based on materials provided by Harvard Medical School. Note: Materials may be edited for content and length.


Cite This Page:

Harvard Medical School. "Clot-Busting Drugs Linked To Increased Mortality In Elderly." ScienceDaily. ScienceDaily, 11 March 2002. <www.sciencedaily.com/releases/2002/03/020311075336.htm>.
Harvard Medical School. (2002, March 11). Clot-Busting Drugs Linked To Increased Mortality In Elderly. ScienceDaily. Retrieved December 21, 2014 from www.sciencedaily.com/releases/2002/03/020311075336.htm
Harvard Medical School. "Clot-Busting Drugs Linked To Increased Mortality In Elderly." ScienceDaily. www.sciencedaily.com/releases/2002/03/020311075336.htm (accessed December 21, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, December 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Best Tips to Curb Holiday Carbs

The Best Tips to Curb Holiday Carbs

Buzz60 (Dec. 19, 2014) — It's hard to resist those delicious but fattening carbs we all crave during the winter months, but there are some ways to stay satisfied without consuming the extra calories. Vanessa Freeman (@VanessaFreeTV) has the details. Video provided by Buzz60
Powered by NewsLook.com
Sierra Leone Bikers Spread the Message to Fight Ebola

Sierra Leone Bikers Spread the Message to Fight Ebola

AFP (Dec. 19, 2014) — More than 100 motorcyclists hit the road to spread awareness messages about Ebola. Nearly 7,000 people have now died from the virus, almost all of them in west Africa, according to the World Health Organization. Video provided by AFP
Powered by NewsLook.com
Researchers Test Colombian Village With High Alzheimer's Rates

Researchers Test Colombian Village With High Alzheimer's Rates

AFP (Dec. 19, 2014) — In Yarumal, a village in N. Colombia, Alzheimer's has ravaged a disproportionately large number of families. A genetic "curse" that may pave the way for research on how to treat the disease that claims a new victim every four seconds. Duration: 02:42 Video provided by AFP
Powered by NewsLook.com
The Best Protein-Filled Foods to Energize You for the New Year

The Best Protein-Filled Foods to Energize You for the New Year

Buzz60 (Dec. 19, 2014) — The new year is coming and nothing will energize you more for 2015 than protein-filled foods. Fitness and nutrition expert John Basedow (@JohnBasedow) gives his favorite high protein foods that will help you build muscle, lose fat and have endless energy. Video provided by Buzz60
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins