Myocardial Infarction: ocular haemorrhage is uncommon with thrombolytic therapy.

Clinical bottom line (level 4)

  1. 0.03% of patients with acute myocardial infarction who had been randomised to a thrombolytic therapy had an ocular haemorrhage.
Mahaffey et al: Journal of the American College of Cardiology 1997; 30: 1606-1610
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The study

Setting: 1081 centres, USA and Europe (15 countries)

41021 patients (aged mean 62 years, 75% male) acute myocardial infarction presenting within 6 hours of symptom onset

Excluded if
  • recent noncompressible vascular puncture
  • severe, uncontrolled hypertension (systolic blood pressure > or = 180 mmHg unresponsive to therapy)
  • previous treatment with streptokinase or alteplase
  • recent trauma or major operation
  • previous participation in the trial
  • active bleeding
  • history of previous stroke



Note:
  • 40889 (99.7%) of patients had enough data to be analysed for this paper.
  • Patients with an acute myocardial infarction were randomised to one of four thrombolytic strategies (streptokinase and heparin in two different doses; alteplase and heparin; streptokinase and alteplase and heparin).

The evidence


differential diagnosis number of patients prevalence
(95% CI)
ocular haemorrhage 12 0.03%
(0.01% to 0.05%)

Comments

  1. 11 of the haemorrhages were extraocular and the other intraocular.
  2. Data was taken from the GUSTO I trial.

Citation

  1. Mahaffey KW, Granger CB, Toth CA, et al: Diabetic retinopathy should not be a contraindication to thrombolytic therapy for acute myocardial infarction: Review of ocular hemorrhage incidence and location in the GUSTO-I trial. Journal of the American College of Cardiology 1997; 30: 1606-1610
Contributor: Clare Wotton and Bob Phillips, December 1999
Reviewer:

Clinical Question.
Patient acute myocardial infarction
Intervention or Exposure
Outcome prevalence of ocular haemorrhage