The current role of thrombolytic therapy in the treatment of acute myocardial infarction

• Published in: Fibrinolysis & Proteolysis 1999-03, Vol.13 (2), p.78-90
• Main Authors: Pislaru, S.V., Van de Werf, F.J.
• Format: Article
• Language: English
• ISSN: 1369-0191; 1532-222X
• DOI: 10.1016/S0268-9499(99)90083-8

Thrombolytic therapy has become the mainstay of treatment for acute transmural myocardial infarction. The current guidelines recommend that thrombolytic therapy be administered to all patients who have symptoms suggestive of an acute myocardial infarction and who present to the hospital within 12 h of symptom onset, with ST-segment elevation and/or new bundle-branch block on their ECG. Absolute contra-indications for thrombolysis are a history of haemorrhagic stroke; active internal bleeding; recent trauma, surgery, or traumatic resuscitation; intracranial neoplasms; and suspected aortic dissection. Present fibrinolytic regimens have a number of shortcomings, including the failure to induce early and sustained reperfusion in as many as 40–50% of the patients, and to prevent reocclusion in another 10–20% of the patients. The efforts in improving thrombolysis are focused on the development of new drugs (fibrinolytics, anticoagulants, and antiplatelet agents) as well as the evaluation of new doses and combinations of established agents. This paper reviews the currently accepted standards of thrombolytic therapy and outlines the future research directions.