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Thrombolytics Are Not Contraindicated in the Very Old
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The article by Soumerai et al1 regarding
the effectiveness of thrombolytic therapy in the elderly was an interesting
and important analysis, but, similar to Thiemann et al2 in
their article questioning the use of thrombolytics in the elderly, they start
with the premise that the data of the Fibrinolytic Therapy Trialists' (FTT)
Collaborative Group3 (combined data from
9 placebo-controlled thrombolytic trials involving at least 1000 patients)
demonstrated only minimal benefit for those older than 75 years. In fact,
in the latter study, the data for the elderly was terribly misrepresented
because only 5 of the 9 studies (GISSI-1 [Gruppo Italiano per lo Studio della
Sopravivenza nell'Infarto Miocardio],4 ISIS-2
[Second International Study of Infarct Survival Collaborative Group],5 ISIS-3 [Third International Study of Infarct
Survival Collaborative Study Group],6 EMERAS
[Estudio Multicentro Estreptoquinsa Republicas de America del Sur],7 and LATE [Late Assessment of Thrombolytic Efficacy
Study Group]8) included significant numbers
of elderly . . . [Full Text of this Article]
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