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Complete data were available on 20,768 patients.A total of 3236(1.14 percent)had strokes in the hospital;0.36 percent had hemorrhagic strokes, 0.48 percent ischemic strokes,and 0.30 percent strokes of undefined cause. Patients treated with t-PA had a small but significant excess of stroke as compared with those who received streptokinase(1.33 vs.0.94 percent; adjusted odds ratio,1.42;95 percent confidence interval,1.09 to 1.84).The administration of subcutaneous heparin in addition to a thrombolytic agent did not increase the risk of stroke(risk with heparin,1.13 percent;without heparin,1.14 percent).Older age,a higher Killip class,and the occurrence of anterior infarction significantly increased the risk of stroke,whereas a higher body-mass index or a history of hypertension,diabetes,or smoking did not.Conclusions.Patients with acute myocardial infarction who receive thrombolytic therapy have a small risk of stroke.Treatment with t-PA as compared with streptokinase resulted in a small but significant excess of stroke.Subcutaneous heparin,given together with t-PA or streptokinase and aspirin,did not result in a increased risk of stroke. |
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