Preclinical Thrombolysis

Preclinical lysis is not indicated for transport times of less than 60 minutes (according to ERC) or less than 90 minutes (according to AHA and ACC).

For longer transport times to a cardiology center, preclinical lysis is considered a Class IIb recommendation of the AHA. This means that lysis is preclinically only of questionable benefit and potentially dangerous.

The reason for this current assessment is the fact that acute PTCA is superior to lysis in the infarct. If lysis is ineffective beforehand, the PTCA in acute infarction is only questionably efficient and not recommended. Moreover, in cardiogenic shock, a possible complication of acute myocardial infarction, lysis is completely ineffective and also not indicated (class III according to AHA). In these cases, the only promising therapy is rescue PTCA, the results of which can be improved with intra-aortic counterpulsation (Class I AHA recommendation), the use of which is contraindicated by thrombolytics.