Bleeding after thrombolysis in acute myocardial infarction

232 consecutive patients with acute myocardial infarction weretreated either with 2 x 10⁶ IU urokinase as an intravenous bolusinjection, or 250000 IU streptokinase intracoronary, or 60 mgrecombinant tissue-type plasminogen activator (rt-PA) over 90min. All patients enrolled had chest pain for more than 30 minand less than 3 h before admission and a typical electrocardiogram.Contra-indications to thrombolytic treatment were absent. Allbleeding complications occurring within 24 h after admissionwere assumed to be due to thrombolytic therapy. Bleeding complicationsoccurred in 14 patients (6.5%). Only seven patients receiveda blood transfusion (3%). No correlation was evident betweenprevious hypertension, diabetes mellitus, smoking, sex, age,fibrinogen level before and 24 h after thrombolytic therapyand bleeding complications. The risk of bleeding was not significantlydifferent between the different thrombolytic regimens despitemarked differences in the fall of the fibrinogen level. Thedecrease of fibrinogen following thrombolytic therapy did notinfluence the patency rate of the infarct vessel. Thrombolytictherapy in acute myocardial infarction is a safe treatment evenamong patients advanced in years and with medically controlledhypertension and diabetes mellitus, irrespective of the kindof thrombolytic treatment.