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(Circulation. 2001;103:1171.)
© 2001 American Heart Association, Inc.

Current Perspective

Bolus Fibrinolysis

Risk, Benefit, and Opportunities

Paul W. Armstrong, MD; Christopher Granger, MD; Frans Van de Werf, MD

From the University of Alberta, Edmonton, Alberta, Canada (P.W.A.); Duke Clinical Research Institute, Durham, NC (C.G.); and University Hospital Gasthuisberg, Leuven, Belgium (F.V.d.W.).

Correspondence to Paul W. Armstrong, MD, 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2H7. E-mail paul.armstrong@ualberta.ca

Key Words: brain • circulation • fibrinolysis

	Introduction

 
Fibrinolytic therapy for acute ST-segment elevation myocardial infarction has made a major contribution to the care of thousands of patients worldwide.¹ Over the past decade, there have been tremendous advances in the care of such patients, including an enhanced assessment of both the risks of the infarction and the potential for complicating intracranial hemorrhage (ICH), more effective reperfusion strategies, and commensurate improvements in the approach to primary angioplasty and stenting.^{2 3 4} Recently, a meta-analysis of phase III megatrials involving several different fibrinolytic agents used for acute myocardial infarction suggested that agents administered as a bolus are associated with an excess risk of ICH.⁵

The advantages of long-acting, third-generation fibrinolytic agents administered as a simple, single- or double-bolus injection are substantial when compared with prior agents that require sustained infusions and are often introduced by a bolus, with or without a step-down infusion. Within contemporary emergency departments, physicians and nurses are required to deal with a growing and increasingly complicated array of available therapies, not only for acute coronary syndromes, but for many other conditions as well. These demands are often accented by resource constraints; hence, simple bolus fibrinolytic regimens are a welcome innovation for those healthcare workers on the front lines, and such regimens are less likely to engender medication errors. However, the relationship between fibrinolytic dosing errors and morbidity and mortality is complex. Thus, whereas a higher frequency of modest dosing errors was identified after therapy with recombinant tissue-type plasminogen activator (rt-PA) than with tenecteplase (TNK-tPA) in the Assessment of . . . [Full Text of this Article]

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