Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

Abstract

Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r = −0.466, P = 0.005) and MB (r = 0.403, P = 0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r = −0.380, P < 0.001), MB (r = 0.212, P = 0.014), and AMI (r = −0.231, P = 0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.

Myocardial Injury Caused by Severe Blow

“…Regarding anticoagulation therapy, patients should be individually managed, taking into consideration the benefits and risks associated with the therapy. [5][6][7] In conclusion, we reported a patient with myocardial infarction who initially presented with blunt chest trauma. Careful medical interview and physical examination can be important clues to hidden diseases even in seemingly healthy subjects.…”

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“…Mongkhon et al(2017) dalam penelitiannya yang menggunakan metode literature review menyebutkan bahwa injeksi fibrinolitik sebelum merujuk pasien STEMI untuk melakukan IKP tidak menunjukkan manfaat klinis, tetapi dapat meningkatkan risiko perdarahan mayor. Penelitian Nascimento et al(2014) menyebutkan bahwa terapi yang direkomendasikan oleh guideline bagi pasien STEMI berada dalam batas manfaat klinis dengan tingkat kematian sekitar 5%, dimana hasil tersebut menggambarkan bahwa manfaat klinis bersih masih lebih besar daripada risiko perdarahan. Wong et al(2019) dalam penelitian terbarunya menyebutkan bahwa terapi reperfusi yang tepat waktu menjadi landasan pemberian terapi pada pasien STEMI untuk mencapai keefektifan terapi.Terdapat perbedaan pendapat dalam review efektifitas fibrinolitik pada pasien STEMI sehingga penulis ingin melakukan systematic reviewmengenai efektifitas terapi fibrinolitik pada pasien sindrom koroner akut (STEMI).…”

Predictors of Myocardial Reperfusion in Patients with ST-Elevation Myocardial Infarction Following Thrombolytic Treatment in Rural Community

“…Patients with a lower severity of cardiac symptoms at hospital arrival had a lower mortality. Furthermore, decreased prehospital delay and access to definitive treatment contributed to positive patient outcomes [12][13][14].…”