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January 2, 1991

Intravenous Thrombolysis and Coronary Revascularization Rates

Author Affiliations

George Washington University Washington, DC

George Washington University Washington, DC

JAMA. 1991;265(1):28. doi:10.1001/jama.1991.03460010027018

To the Editor.—  The impact of intravenous thrombolysis on the rates of short-term interventional procedures (cardiac catheterization, angioplasty, and bypass surgery) was addressed recently by Naylor and Jaglal1 and, in an accompanying editorial, by Schlant.2 They explained the "paradoxic" increase in revascularization procedures (angioplasty and bypass surgery) on the basis that, although thrombolysis takes care of the offending occlusive thrombus, there remains the significant underlying atherosclerotic plaque, which may or may not rerupture to cause post-infarction angina or sudden ischemic death. But neither article offered to explain why the number of revascularization procedures was higher in patients treated with tissue plasminogen activator than in the streptokinase-treated patients.1 In the current controversy concerning whether tissue plasminogen activator is superior to streptokinase as a thrombolytic agent,3 this finding by Naylor and Jaglal simply adds more fuel to the fire. Finally, instead of the answer "Only if we have