Therapy

• active bleeding ^a
• recent surgery or trauma ^c
• recent stroke ^a
• active peptic ulcer disease ^d  
• evidence of aortic dissection ^d  

Why?

• Thrombolysis reduces mortality, but there is a small increased risk of stroke. ^a  
• Fewer patients have ventricular arrhythmias. ^a
• It is cost-effective. ^a

Thrombolysis reduces mortality but slightly increases the risk of stroke

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
suspected myocardial infarction a	thrombolysis	no thrombolysis	death at 4 weeks	12%	16% (12% to 20%)	54 (43 to 74)
			any stroke at 4 weeks	0.76%	-52% (-79% to -28%)	-250 (-420 to -180)

Thrombolysis reduces VT and VF

Patient	Treatment	Comparison	Outcome	CER	ARR (95% CI)	NNT (95% CI)
myocardial infarction a	thrombolysis	no thrombolysis	ventricular tachycardia or fibrillation at at discharge	-%	2.7% (0.5% to 4.8%)	37 (21 to 200)

• Patients receive benefit from thrombolysis for up to 12 hours, but the reduction in mortality decreases the longer thrombolysis is delayed. ^a

Early thrombolysis saves lives

Thrombolysis given within a	NNT  (95% CI)
1 hour	15  (11 to 26)
2 to 3 hours	27  (18 to 50)
3 to 6 hours	38  (27 to 71)
6 to 12 hours	34  (25 to 52)
12 to 24 hours	110  (NNT = 45 to infinity,  NNH = 200 to infinity)