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Rethrombolysis in acute myocardial infarction

Three Part Question

In [reinfarction after thrombolytic therapy for acute myocardial infarction] does [rethrombolysis] reduce [mortality]?

Clinical Scenario

A 61 year old male with no previous cardiac history presents with chest pain and a diagnosis of acute myocardial infarction is made. He is thrombolysed but the pain does not settle and the electrocardiogram shows persistent ST elevation after two hours. You wonder whether rethrombolysis would be of any benefit and reduce mortality.

Search Strategy

Medline 1990 – 01/05 using the Ovid interface.
[(exp rethrombolysis OR AND (exp myocardial infarction OR myocardial OR ) AND (exp reinfarction OR )] LIMIT to human AND English language.

Search Outcome

Altogether 4 papers were found of which one was relevant.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Barbash et al
2301 patients reinfarcted of which 874 were rethrombolysedRetrospective comparative analysis30 day mortalitySignificantly reduced in the rethrombolysed and revascularized group compared to conservative treatment groupThe relative advantages and disadvantages of interventional revascularization compared with repeat thrombolysis for reinfarction have not been quantified Low event rates, particularly for overall stroke and intracranial hemorrhage, leave the analysis underpowered to make strong comparative conclusions between treatment strategies for these important safety outcomes
Incidence of overall strokesNo significant difference in the three groups


There is only one study addressing this question and although it was a large study using the database of two major trials it does not quantify the advantages and disadvantages of interventional revascularization compared with repeat thrombolysis for reinfarction. Randomized trials are necessary to assess the exact risks and benefits of rethrombolysis versus interventional revascularisation. However, the study does show reduced mortality rates with rethrombolysis in reinfarcted patients.

Clinical Bottom Line

The available evidence suggests that rethrombolysis reduces mortality in patients with acute myocardial infarction.


  1. Barbash GI. Birnbaum Y. Bogaerts K et al. Treatment of Reinfarction After Thrombolytic Therapy for Acute Myocardial Infarction. Circulation 103(7)954-960, Feb 20 2001.