State-of-the-Art Review : Management of Patients Who Require Invasive Procedures Immediately Following Thrombolytic Therapy

In recent years the use of thrombolytic ther apy has been demonstrated to be valuable in the treat ment of patients with acute myocardial infarction. Often, because of the frequency of reocclusion of the infarct- related artery, identification of a treatable vascular le sion, or, rarely, failure of thrombolytic therapy, patients will require more invasive procedures to prevent further ischemic injury to the myocardium. These procedures in clude anything from cardiac catheterization to emergency coronary bypass surgery. The perioperative evaluation and management of patients who have recently received thrombolytic therapy requires an understanding of the changes in coagulation proteins that occur with the use of these therapeutic agents. The appropriate understanding and use of antifibrinolytic agents and blood products will allow for these procedures to be performed safely with a minimum of bleeding complications.