The effect of thrombolytic reperfusion on the incidence of arrhythmias was an early concern. It is now realized that, although transient changes in rhythm may occur at the time of reperfusion, overall, during hospitalization, the incidence of serious ventricular arrhythmias does not increase, and late ventricular fibrillation is reduced.
Reperfusion therapy has been associated with a small increase in re-infarction (absolute excess over control patients of about 1 to 2%). This is primarily accounted for by recurrent occlusive events in the infarct-related artery with infarction of previously salvaged myocardium. Differences in re-infarction rates among thrombolytic agents may be accounted for either by differences in initial salvage rates associated with differences in effective early recanalization and/or by a greater tendency to re-occlusion with one vs another regimen (e.g., after tPA vs SK).
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