November 5, 1997

Thrombolytic Therapy for Elderly Patients With Myocardial Infarction-Reply

Author Affiliations

Yale University School of Medicine New Haven, Conn

JAMA. 1997;278(17):1401-1402. doi:10.1001/jama.1997.03550170031017

In Reply.  —Dr Dave raises an interesting point about considering the role of functional status in the use of thrombolytic therapy. It is possible that preadmission functional status is an important predictor of which patients receive thrombolytic therapy. In our retrospective study we did not examine this issue. Whether worse functional status ought to be an important factor is another issue. It is certainly not appropriate to deny efficacious treatments to patients of any age based solely on worse functional status unless there is information that it increases the risk of therapy or compromises its benefit.As suggested by the letter of Dr Bernabei and colleagues, there may be a need to collect information about the importance of comorbidity and functional status on the risks and benefits of thrombolytic therapy. This issue is particularly important since it is likely that the thrombolytic therapy trials did not include a large number of the

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