BENEFITS OF THROMBOLYSIS BEFORE HOSPITALIZATION FOR ACUTE CORONARY SYNDROME

Аннотация

The review describes the features of thrombolytic therapy in patients with acute myocardial infarction in detail. Thrombolytic therapy helps to reduce 30-day mortality in myocardial infarction from 17-18% to 5-8%. The issues of the optimal period of thrombolysis from the onset of the clinical manifestations of a heart attack, alternative methods for restoring coronary blood flow, indications and contraindications, complications and side effects, and methods for evaluating the effectiveness of thrombolysis are highlighted. The main fibrin-selective and fibrin-non-selective fibrinolytic drugs: streptokinase, alteplase, tenecteplase are listed. The results of large randomized clinical trials on fibrinolytic therapy of myocardial infarction are presented. The possibilities of increasing the effectiveness and safety of fibrinolytics by combining them with acetylsalicylic acid and heparins are discussed. KEYWORD: myocardial infarction, thrombolysis, fibrinolytics Acute myocardial infarction (AMI) in most cases develops as a result of intracoronary thrombosis formed over damaged atherosclerotic plaque [12]. Thrombolytic drugs began to be used in patients with acute myocardial infarction more than 50 years ago . Over the years, it has been shown that emergency restoration of coronary blood flow leads to a decrease in the focus of necrosis, makes the process of its formation reversible, and prevents the deterioration of the function of the affected myocardium . The use of thrombolytic therapy led to a decrease in 30-day mortality in patients with myocardial infarction to 5-8% , while in the "pre-fibrinolytic era" it reached 17- 18%.But it is obvious that even now myocardial infarction remains one of the most prognostic formidable diseases, with the largest number of deaths observed in the first hours of the disease: 28% of patients die during the first hour of the disease, 38% within 4 hours and 46% in the first hours. 24 hours [6,7,9,10]. In this connection, one of the main tasks of treating a patient with myocardial infarction is the earliest possible, complete and sustainable restoration of coronary blood flow [12]. All available guidelines are based on the results of RCTs comparing primary PCV and TLT, as well as data from registries [1, 13]. Since most of the guidelines were 29 ACADEMIC RESEARCH IN MODERN SCIENCE International scientific-online conference published several years ago, the most recent results have obviously not been taken into account. All experts agree that the time factor is key and reperfusion therapy should be started as early as possible. The American Heart Association (AHA) and the American College of Cardiology (ACC) favor pre-hospital thrombolysis over PCI, emphasizing that the timing of therapy is more important than the method of reperfusion. The ACC and ACC guidelines state that prehospital thrombolysis can be performed if there is confirmation of MI with 8T segment elevation on the ECG, interpreted by the on-site physician or referred to a specialist. Further, it is advisable to complete a reperfusion checklist to ensure that the patient has no contraindications to such therapy and to identify high-risk patients who will benefit more from primary PCI. Pre- hospital thrombolysis should be performed within 30 minutes from the arrival of the ambulance to the patient. If a fibrinolytic agent cannot be administered prehospital and If the patient is transported to a hospital where PCI is not possible, the door-to-needle time (from arrival to the hospital to thrombolytic administration) should not exceed 30 minutes. However, if the hospital has facilities for under leather intervention V, the door-to-balloon time (from arrival at the hospital to balloon inflation at the catheter lab) should not exceed 90 min [4].If a patient is admitted to a center that is not equipped to perform under leather intervention and cannot be transferred to another hospital and is unable to perform under leather intervention within 90 minutes of the first medical contact, thrombolytic therapy should be started no later than 30 minutes from admission to the hospital if no contraindications (level of evidence B). The goal of organizing the patient care system is the interval of the total "ischemic time" at the stages of care, not exceeding 120 minutes. The goal for each treatment step is to: the time from the onset of symptoms to the call of an ambulance - 5 minutes; transfer of the call by the EMS dispatcher to the EMS team - 1 min; arrival of the ambulance crew at the place of call - 8 minutes, conducting an ECG and deciding on prehospital fibrinolytic therapy, if possible, and the time before TLT will be less than 30 minutes; if it is decided to take the patient to the hospital without the possibility of PCV, the “door-to-needle” time should be less than 30 minutes; if it is decided to deliver the patient to the hospital with the possibility of PCV, the time from calling the ambulance to the start of the balloon