Search

Objectives. Thrombolysis is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI) living in rural areas with long transfer delays to percutaneous coronary intervention (PCI). This trial compares two different strategies following thrombolysis: to transfer all patients for immediate coronary angiography and intervention, or to manage the patients more conservatively. Design. The NORwegian study on DIstrict treatment of STEMI (NORDISTEMI) is an open, prospective, randomized controlled trial in patients with STEMI of less than 6 hours of duration and more than 90 minutes expected time delay to PCI. A total of 266 patients will receive full-dose thrombolysis, preferably prehospitally, and then be randomized to either strategy. Our primary endpoint is the one year combined incidence of death, reinfarction, stroke or new myocardial ischaemia. The study is registered with ClinicalTrials.gov, number NCT00161005. Results. By April 2006, 109 patients have been randomized. Thrombolysis has been given prehospitally to 52% of patients. The median transport distance from first medical contact to catheterization laboratory was 155 km (range 90–396 km). Results of the study are expected in 2008. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy . Design. A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken. Results. For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were €19 250 (NOK 154 000) and €29 250 (NOK 234 000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were €24 000 (NOK 192 000) and €29 250 (NOK 234 000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality. Conclusion . Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment. [ABSTRACT FROM AUTHOR]

A 76-year-old woman receiving warfarin after aortic valve replacement experienced prosthetic valve thrombosis during dicloxacillin therapy. Successful thrombolysis was achieved with tissue plasminogen activator. The international normalized ratio (INR) on admission was reduced to 1.4 and an increased warfarin dosage was required for three weeks following discontinuation of dicloxacillin treatment in order to maintain therapeutic INRs. Careful monitoring of INRs and titration of the warfarin dosage is recommended when dicloxacillin is prescribed to patients receiving warfarin. [ABSTRACT FROM AUTHOR]