Prehospital fibrinolysis

Accessibility of PPCI if anticipated FMC-device is ≤ 120 minutes in primary care settings is limited In a meta-analysis of 6434 patients, Laurie Morrison et al., showed prehospital fibrinolysis (PHF) compared with in-hospital treatment results in 58-minute reduction in time to treatment(104 versus 162 minutes), highlighted the ability of prehospital therapy to achieve treatment within 2 hours in the majority of individuals, 17% relative, 2.0% absolute mortality reduction at 30 days (pooled odds ratio [OR] 0.83, 95% confidence interval [CI] 0.70 to 0.98 P (0.03 with 1 life saved for every 62 STEMI patients treated with fibrinolytics in the prehospital rather than in-hospital setting. Recently, Mongkhan P et al., in a meta analysis in patients presented to non PCI-capable settings, compared fibrinolytic injection with no injection before referring patients to PCI-capable settings. The primary outcome was MACEs at 30 days. Of 912 articles, three RCTs and three non-RCTs were included. Based on RCTs fibrinolytic injection before the referral has failed to decrease MACEs compared to non-fibrinolytic injection [relative risk (RR) 1.18; 95% confidence interval (CI), 0.89-1.57 p 0.237 .> Fibrinolytic injection has also failed to decrease mortality, re-infarction, and ischemic stroke. On the other hand, was associated with a higher risk of major bleeding.Nonetheless, one size does not fit all and the preferred reperfusion strategy will depend to a large extent on geographical and logistical constraints .