REPLY
Coronary Thrombolysis: A Double-Edged Sword?
Jerry H. Gurwitz, MD;
Robert J. Goldberg, PhD; and
Joel M. Gore, MD
6 July 1999 | Volume 131 Issue 1 | Page 71
IN RESPONSE:
Coronary thrombolysis remains one of the most effective treatments for reducing mortality rates in the setting of acute myocardial infarction. Using the absolute risk reduction estimates presented by Dr. Kessler, 17 to 33 patients who appear to be having an acute myocardial infarction must be treated to save 1 life. Such numbers are generally considered favorable in comparison with other medical interventions. However, as Sackett and colleagues have written, the number needed to treat (NNT) is a measure with real meaning for clinicians in caring for populations but not for individual patients (1).
Not every patient who is treated with thrombolytic therapy will benefit; every patient who is treated will be subjected to the risks associated with this treatment, and a few will sustain serious adverse effects. Coronary thrombolysis is a double-edged sword (2). Practical information on risk factors for the occurrence of intracranial hemorrhage with thrombolytic therapy is necessary to assist clinicians in making decisions about optimal patient selection for treatment. To increase the appropriate use of thrombolytic therapy in eligible patients and to optimize its benefits, clinicians must possess the knowledge to assess which edge of this sword is sharper.
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Author and Article Information
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University of Massachusetts Medical School; Worcester, MA 01655 (Gurwitz)
University of Massachusetts Medical School; Worcester, MA 01655 (Goldberg)
University of Massachusetts Medical School; Worcester, MA 01655 (Gore)
1. Sackett DL, Richardson S, Rosenberg W, Haynes RB.Evidence-Based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone; 1997.
2. Gurwitz JH, Goldberg RJ. Coronary thrombolysis for the elderly—is clinical practice really lagging behind evidence of benefit? JAMA. 1997;277:1723-4.[Medline]
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