> > However, on MIs, I wouldn't thromobolyse on ECG in the
> absence of a good
> > history (to give time of onset of ischaemia)
>
> Why is the time of ischaemia important Matt, or is it that
> you're concerned
> about thrombolysing a ventricular aneurysm?
The risk/ benefit ratio of thrombolysis changes with time since onset of
ischaemia. As far as we know, thrombolysis more than 12 hours after onset is
harmful. LVF post MI is often over 12 hours after onset of pain, so may well
be over 12 hours after onset of painless ischaemia. Also, patients with MIs
but without chest pain are a poorly studied group- we don't know what
benefits thrombolysis may have.
A couple of questions arise out of this:
1. What is the positive predictive value for (MI under 12 hours old/ uder 6
hours old) of any ECG changes you can find?
2. Which units thrombolyse for ECG changes in the absence of pain (and what
is the rationale/ evidence base)? This is not a standard practice here, but
clearly if it is beneficial, it would be worth changing.
Matt Dunn
Warwick
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