Cardiac Electrophysiology Consultants of South Texas, P.A.

Medical Center Tower I
7950 Floyd Curl Drive
Suite 803
San Antonio, TX 78229
tel: 210-615-9500
fax: 210-615-9600
email: office at
Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart Current Insurance Plans: We accept most major commercial insurance plans. Please call for details.
Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation.
No insurance? No problem! Consider our affordable Fee for service (direct pay).
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General information about the heart for patients, their family members, and concerned laymen

Thrombolytic ("Clot Buster") Therapy
     Most myocardial infarctions ("heart attacks") are caused by thrombi in a coronary artery. "Thrombi" are just like blood clots, except that clots form outside the body and thrombi form inside the body. Beginning in 1978, we have learned that thrombi can be dissolved or broken relatively safely in people who are having an acute myocardial infarction (MI), and that people live longer and healthier lives when the thrombi are destroyed than when they are not. The question in the 1990's is how to destroy thrombi most quickly, completely, and reliably at the lowest risk to the person.

The two basic methods are (1) to dissolve the thrombus with a thrombolytic ("clot buster") drug such as streptokinase, tissue plasminogen activator, or urokinase; and (2) to break up the clot and the adjacent atherosclerosis (if any) with balloon angioplasty. In this section, we discuss thrombolytic drugs.

Much effort has been devoted to determining which thrombolytic drug is best. Any real differences are quite small, but tissue plasminogen activator appears to have a small advantage. It is also very expensive, and may carry a slightly increased risk of stroke. The important factor to remember is that each delay of an hour in opening the infarct-related artery carries an increased risk of death of about 1.1%. Thus, whatever can be given most quickly should be given. Not all people suffering from acute MI should receive these drugs.

These drugs should be given only when certain clinical criteria are met. These criteria are designed to ensure that only people who truly have a significant MI receive the drug. This is important because of the risk of bleeding from the drugs themselves.

There are also a number of contraindications to all thrombolytic drugs. "Contraindications" are factors that prohibit or discourage ("absolute" and "relative" contraindications, respectively) giving a drug or doing a procedure. In the case of thrombolytic drugs, the contraindications concern the risk of massive bleeding or of bleeding in places that carry very high risk, such as the brain or the eyes.

When a person who appears to have an acute MI does not have the right clinical criteria or does have a major contraindication, doctors often recommend immediate transport to the cardiac catheterization laboratory for diagnostic cardiac catheterization with the goal of seeing whether urgent angioplasty or coronary artery bypass grafting surgery should be performed. There are some data that suggest that all people with acute MI should go immediately to the cardiac catheterization laboratory instead of receiving thrombolytic drugs because the likelihood of opening the infarct-related artery is higher (90% or better compared with 60%) and because there is a much lower risk of stroke. Other cardiologists argue that thrombolytic drugs are less expensive and, when they work, can work much more quickly than a person can get care in a catheterization laboratory. This is currently a controvery among cardiologists.

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