Cruise ships + thrombolytics

[leviathan]

My grandfather was on a cruise a few months ago and had an MI. I know he was on the ship for at least 12 hours before they were able to transport him into a land hospital. When I looked at his medical records from the ship hospital, I noticed they did not give any thrombolytics. Do cruise ships not carry tPA?!

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[southerndoc]

I thought they did (from talking with a former medical director of a cruise line). Maybe it's specific to the cruise line? Did your grandfather have a contraindication to using it?

 

[deleted109597]

The only reason I could think that they don't is because they aren't set up to manage the complications of tPA. Either that or they felt he wasn't a candidate. Maybe the doctor was from another country (many cruise ships are of international registry), and being European, felt anyone older than a certain age should just die instead of receive medical care that would cost the taxpayers more money.

 

[Apollyon]

One of the things you have to be able to do as a cruise ship doc is administer thrombolytics. It's not a political or foreign thing - just look at any cruise ship agency's requirements about being a ship's physician.

 

[leviathan]

The only reason I could think that they don't is because they aren't set up to manage the complications of tPA. Either that or they felt he wasn't a candidate. Maybe the doctor was from another country (many cruise ships are of international registry), and being European, felt anyone older than a certain age should just die instead of receive medical care that would cost the taxpayers more money.

Well it wasn't costing taxpayers money, because we got a bill for about $3000 after his care there, which took several months to get reimbursed by his medical insurance company.

I thought they did (from talking with a former medical director of a cruise line). Maybe it's specific to the cruise line? Did your grandfather have a contraindication to using it?

Not that I'm aware of. He was 89 at the time, but extremely healthy relative to his age...still went gofling every week, went for walks every day. No recent surgery, normotensive, no history of any bleeding disorders or any intracranial bleeds or aneurysms.

Anyway, this was back in May, and he actually died secondary to complications of the MI within about a week. It bothered me at the time when I read his bill and noticed that they did not try tPA, and I thought I'd raise the issue here to see if anyone might have an idea why they would not have done it.

 

[GeneralVeers]

Being 89 is a relative contraindication to thrombolytics.

 

[docB]

Just to clarify for the discussion (and sorry for your loss) was he having an STEMI that met criteria for lytics?

As for managing the complications of lytics I would take the approach the an intracranial bleed and an aortic dissection post lytics will be highly unlikely to be survivable. Other complications like GI bleed could be managed supportively.

Being 89 does put the patient at higher risk of complications but in a highly functional 89 year old who is having a major MI or CVA that is likely to result in a catastrophic reduction in quality of life I will offer lytics.

 

[PaddyofNine]

and being European, felt anyone older than a certain age should just die instead of receive medical care that would cost the taxpayers more money.

😱

That's right. Us crazy hippy Europeans. If she's older than 50, just let her die off, that's what I say...

 

[leviathan]

Just to clarify for the discussion (and sorry for your loss) was he having an STEMI that met criteria for lytics?

Thanks. I'm pretty OK with the loss of my grandpa now, so that's why I'm totally OK discussing it.

I never got to see any ECG or hear what they found, but apparently his trops were sky high and he had pulmonary edema. He had no chest pain at the time, he was only feeling short of breath due to the pulm edema and he personally thought it was pneumonia, until they found out he had a cardiac hx with 1 MI back in the 80s.

As for managing the complications of lytics I would take the approach the an intracranial bleed and an aortic dissection post lytics will be highly unlikely to be survivable. Other complications like GI bleed could be managed supportively.

Being 89 does put the patient at higher risk of complications but in a highly functional 89 year old who is having a major MI or CVA that is likely to result in a catastrophic reduction in quality of life I will offer lytics.

Hmm...I guess there's no way to ever figure out why they were not given then, if everyone says 'lytics are carried on cruise ships and he didn't have any absolute contraindications.

 

[jbar]

another question would be time. I don't know the TPA protocols for MI but I know for stroke they won't use it beyond 3 hours. I could see the MD deciding TPA wouldn't be much help if the patient presented saying "yeah, I had this shortness of breath/chest pain starting 24 hours ago." He/she might have decided that whatever heart muscle was going to die had died since it had been awhile but I'm not up on the protocols.

 

[SoCuteMD]

Lev - I'm sorry for your loss.

 

[leviathan]

Lev - I'm sorry for your loss.

Thanks, SoCute.