THE ROLE OF THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION

Thrombolytic therapy is widely available and easily administered and can restore IRA flow. IRA patency restored by thrombolysis salvages ventricular function and reduces mortality rates, albeit with an increased risk of hemorrhagic stroke. The risk of coronary reocclusion after t-PA administration can be reduced with concomitant use of intravenous heparin given in therapeutic doses. It appears that, in terms of mortality reduction and myocardial salvage, the greatest benefit is achieved when early IRA perfusion is normal (TIMI grade 3). Unfortunately, only 50% of patients treated with the most aggressive regimens will achieve normal flow when assessed 90 min after initiating thrombolysis. New strategies using currently available agents given in different dosing regimens, combinations of strategies, and new antithrombotic agents hold the promise of increasing early patency and further reducing both mortality and ventricular dysfunction.