Perspectives on current, future thrombolytic therapy for acute myocardial infarction

This review assesses current options in thrombolytic therapy for acute myocardial infarction (AMI) and surveys investigational thrombolytic agents. Safety, efficacy, and cost are compared among the four thrombolytics currently approved for AMH: streptokinase, anistreplase, recombinant tissue-type plasminogen activator (rt-PA), and reteplase. Streptokinase offers a large cost advantage and a possible safety edge over anistreplase, While rt-PA has higher rates of intracranial hemorrhage relative to streptokinase, it offers better reperfusion and an edge in mortality. Because it costs significantly more than streptokinase, rt-PA is best reserved for use soon after onset of chest pain and in patients at low risk for intracranial hemorrhage. Reteplase, the newest approved agent, is as safe and effective as streptokinase and rt-PA; its superior perfusion, however, does not appear to yield a mortality advantage over rt-Pk.