Thrombolytic therapy: a review of the literature on streptokinase and tissue plasminogen activator with implications for practice.

Thrombolytic therapy has had a major impact on the outcome of AMI patients. For the first time, medicine has a means of interrupting the process of myocardial necrosis and limiting the potential size of the infarction. For those patients who can receive thrombolytic therapy and who seek medical attention within the first few hours of infarction, the impact of successful thrombolysis on ventricular function is most substantial. Also, in some patients with continuing symptoms, benefit may be seen beyond the 3- to 6-hour time limit. However, the therapy is not yet perfect. No thrombolytic agent has consistently been able to attain reperfusion in more than 75 per cent of those treated. There are significant bleeding risks associated with these medications, and the best adjunctive therapy to prevent reocclusion has not been established. Nursing has also been significantly affected by the addition of thrombolysis to the coronary care and emergency units. The role of identifying appropriate patients, caring for the patient during thrombolysis, and dealing with complications of the therapy has added a new dimension to the nursing care of the infarction patient. In the era of nursing shortages, these additional tasks may be difficult to welcome with enthusiasm. However, when the possibility of discharging a patient from the coronary care unit with little or no myocardial damage is entertained, the additional burden of thrombolytic therapy seems well worth the effort.