PMID- 15383484
OWN - NLM
STAT- MEDLINE
DCOM- 20041026
LR  - 20181130
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 126
IP  - 3 Suppl
DP  - 2004 Sep
TI  - Thrombolysis and adjunctive therapy in acute myocardial infarction: the Seventh 
      ACCP Conference on Antithrombotic and Thrombolytic Therapy.
PG  - 549S-575S
AB  - This chapter about antithrombotic therapy for acute myocardial infarction (MI) is 
      part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: 
      Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that 
      the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests 
      that individual patients' values may lead to different choices (for a full 
      understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among 
      the key recommendations in this chapter are the following: For patients with 
      ischemic symptoms characteristic of acute MI of < 12 h in duration, and 
      ST-segment elevation or left bundle-branch block (of unknown duration) on the 
      ECG, we recommend administration of any approved fibrinolytic agent (Grade 1A). 
      We recommend the use of streptokinase, anistreplase, alteplase, reteplase, or 
      tenecteplase over placebo (all Grade 1A). For patients with symptom duration < 6 
      h, we recommend the administration of alteplase over streptokinase (Grade 1A). 
      For patients with known allergy or sensitivity to streptokinase, we recommend 
      alteplase, reteplase, or tenecteplase (Grade 1A). For patients with acute 
      posterior MI of < 12 h duration, we suggest fibrinolytic therapy (Grade 2C). In 
      patients with any history of intracranial hemorrhage, closed head trauma, or 
      ischemic stroke within past 3 months, we recommend against administration of 
      fibrinolytic therapy (Grade 1C+). For patients with acute ST-segment elevation MI 
      whether or not they receive fibrinolytic therapy, we recommend aspirin, 160 to 
      325 mg p.o., at initial evaluation by health-care personnel followed by 
      indefinite therapy, 75 to 162 mg/d p.o. (both Grade 1A). In patients allergic to 
      aspirin, we suggest use of clopidogrel as an alternative therapy to aspirin 
      (Grade 2C). For patients receiving streptokinase, we suggest administration of 
      either i.v. unfractionated heparin (UFH) [Grade 2C] or subcutaneous UFH (Grade 
      2A). For all patients at high risk of systemic or venous thromboembolism 
      (anterior MI, pump failure, previous embolus, atrial fibrillation, or left 
      ventricular thrombus), we recommend administration of IV UFH while receiving 
      streptokinase (Grade 1C+).
FAU - Menon, Venu
AU  - Menon V
AD  - Division of Cardiology, University of North Carolina at Chapel Hill, 27599, USA.
FAU - Harrington, Robert A
AU  - Harrington RA
FAU - Hochman, Judith S
AU  - Hochman JS
FAU - Cannon, Christopher P
AU  - Cannon CP
FAU - Goodman, Shaun D
AU  - Goodman SD
FAU - Wilcox, Robert G
AU  - Wilcox RG
FAU - Schunemann, Holger J
AU  - Schunemann HJ
FAU - Ohman, E Magnus
AU  - Ohman EM
LA  - eng
PT  - Comparative Study
PT  - Guideline
PT  - Journal Article
PT  - Practice Guideline
PT  - Review
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aspirin/adverse effects/therapeutic use
MH  - Clopidogrel
MH  - Contraindications
MH  - Drug Therapy, Combination
MH  - Electrocardiography/drug effects
MH  - Evidence-Based Medicine
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Injections, Subcutaneous
MH  - Myocardial Infarction/blood/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Secondary Prevention
MH  - *Thrombolytic Therapy
MH  - Ticlopidine/adverse effects/*analogs & derivatives/therapeutic use
RF  - 162
EDAT- 2004/09/24 05:00
MHDA- 2004/10/27 09:00
CRDT- 2004/09/24 05:00
PHST- 2004/09/24 05:00 [pubmed]
PHST- 2004/10/27 09:00 [medline]
PHST- 2004/09/24 05:00 [entrez]
AID - S0012-3692(15)31503-8 [pii]
AID - 10.1378/chest.126.3_suppl.549S [doi]
PST - ppublish
SO  - Chest. 2004 Sep;126(3 Suppl):549S-575S. doi: 10.1378/chest.126.3_suppl.549S.