Don't you need to take morbidity into account; you know, heart failure,
exercise tolerance and the like?
AF
----- Original Message -----
From: "Jonathan Benger" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, October 15, 2002 2:27 PM
Subject: Re: Thrombolysis and previous surgery
> >From the FTT review (1):
>
> Numbers needed to treat with thrombolysis (to save one life):
> Anterior MI: 28
> Inferior MI: 120
>
> Numbers needed to harm with thrombolysis (to cause one death):
> ST depression: 72 (the relation of this to posterior MI is unclear)
> Normal ECG: 144
>
> The 95% confidence intervals of the NNT in inferior MI overlap with those
> for the NNH in normal ECGs. This is not the case for anterior MI, and the
> difference is quite striking.
>
> Therefore, the location of the MI should be taken into account (along with
> age, co-morbidity, sex, warfarin use, recent surgery, bleeding risk, etc,
> etc) when considering the risk/benefit ratio for each patient eligible for
> thrombolysis.
>
> Regards,
>
> Jonathan Benger.
> SpR, Bath.
>
> (1) Fibrinolytic therapy trialists' (FTT) collaborative group. Indications
> for fibrinolytic therapy in suspected acute myocardial infarction:
> collaborative overview of early mortality and major morbidity results of
all
> randomised trials of more than 1000 patients. Lancet 1994;343:311-322.
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Goat
> Sent: 13 October 2002 20:59
> To: [log in to unmask]
> Subject: Re: Thrombolysis and previous surgery
>
>
> I couldn't remember where I had heard this. Thanks for reminding me,
> Rowley.
>
> When I saw the original post, I went on the hunt for any guidelines on
> the web differentiating between inferior and anterior MI for lysis - got
> zip. Our Trust guidelines don't differentiate between MI sites for
> lysis.
>
> Is this one of those cases where the "evidence" has been over-sold?
>
> Which of the many lysis trials can we get such info from? I coudl find
> nothing on a quick title search on medline this pm.
>
> Yes, you're right Rowley, I am just too lazy to look further myself, or
> is it just too tired! Throw me a bone!
>
> Goat
>
>
>
> In article <[log in to unmask]>,
> Rowley Cottingham <[log in to unmask]> writes
> >Um, there is no evidence that thrombolysis affects the outcome in
inferior
> MIs,
> >you know.
> >
> >Best wishes,
> >
> >
> >Rowley Cottingham
> >
> >[log in to unmask]
> >http://www.emergencyunit.com
>
> Dr G Ray
> A&E
> Sussex
> Reply to [log in to unmask]
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