Drug Safety

, Volume 26, Issue 6, pp 367–379 | Cite as

Safety of Thrombolysis during Cardiopulmonary Resuscitation

Current Opinion


The prognosis is generally poor for patients who experience a cardiac arrest. The most common causes of sudden cardiac arrest are massive pulmonary embolism (PE) and acute myocardial infarction (MI). While thrombolysis is a first-line treatment option in massive PE and acute MI, cardiopulmonary resuscitation (CPR) has been regarded as a relative contraindication for thrombolysis because of the anticipated bleeding risk caused by traumatic cardiocompressions. However, an increasing number of case reports and clinical studies on thrombolysis during and after CPR highlight an increased frequency of the return of spontaneous circulation and a better neurological outcome of surviving patients. These effects are mainly due to the thrombolysis of macroscopic blood clots and the amelioration of microcirculatory reperfusion.

This article reviews case reports and clinical studies of thrombolysis during and shortly after CPR in order to estimate the risk of severe bleeding events caused by CPR in association with thrombolysis compared with CPR without thrombolysis.

Although thrombolysis per se can cause severe and potentially fatal haemorrhage, there is no evidence that severe bleeding events occur more often when thrombolysis is combined with cardiocompressions. In addition, by far the majority of bleeding complications can be treated effectively. Thus, in many cases, the possible benefit of thrombolysis during CPR seems to outweigh the potential risks. However, there may be a publication bias in some case reports and studies towards reporting successful rather than unsuccessful CPRs. In addition, not enough controlled clinical trials have yet been conducted. Therefore, data from large randomised, multicentre studies are needed to definitely answer the question of the relationship between safety and efficacy of this promising treatment option.

We conclude that the currently available data do not indicate that thrombolysis contributes to a significant increase in bleeding complications when administered during CPR.



We gratefully acknowledge the major input from our former colleague Dr Stephan A. Padosch, University of Bonn, Germany, who made important contributions in many discussions during the development of this manuscript.

F. Spöhr and B.W. Böttiger were supported, in part, by grants of the Medical Faculty of the University of Heidelberg and by the Deutsche Forschungsgemeinschaft (BO 1686/1-1).

There are no conflicts of interest directly relevant to the content of this review.


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© Adis Data Information BV 2003

Authors and Affiliations

  1. 1.Department of AnaesthesiologyUniversity of HeidelbergHeidelbergGermany

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