AGGRESSIVE THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION - LIMITATIONS AND POSSIBILITIES

Several large-scale, placebo-controlled studies have shown a significant reduction in mortality for patients with acute myocardial infarction treated with thrombolytic therapy. Early initiation of treatment and a high, early patency rate of the infarct-related coronary artery are desirable because several studies have documented a direct correlation between the reduction of mortality achieved by thrombolytic therapy and the timeliness and completeness of reperfusion. As a consequence, a number of ways to possibly improve thrombolytic therapy can be identified: 1) organizational improvement such as education of the population in order to shorten the time to inform the emergency system and to initiate treatment in the prehospital phase in order to shorten the ischemic period. 2) Patient selection with the aim to make thrombolysis available to all patients who can derive benefit from this form of treatment. 3) Optimized use of anticoagulants and antiplatelet agents as adjuvant therapy and of thrombolytic agents. New therapeutic regimens and new agents have shown promising results in this area. The promise and the problems of thrombolytic therapy must be weighed against the therapeutic alternatives of conservative therapy on the one hand, and emergency PTCA without thrombolysis on the other hand.