Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 154

In patients undergoing cardiopulmonary resuscitation for an arrest of presumed cardiac origin, the administration of tenecteplase during resuscitation did not improve the 30-day survival, the return of spontaneous circulation, or the neurological outcome, and increased intracranial hemorrhage. During cardiac arrest, the poor systemic perfusion may preclude the delivery of the fibrinolytic agent to its target, explaining the lack of efficacy; also, frequently, there is no acute coronary thrombosis, or thrombosis is not totally occlusive. Bleeding, including intracranial hemorrhage, may be a cause of arrest in a small proportion of patients and is aggravated by thrombolysis.¹⁸⁵ However, after the return of spontaneous circulation in a patient with STEMI, fibrinolytics may be appropriate, as suggested by a small analysis.¹⁸⁶