THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

Thrombolytic therapy is an efficacious although underused therapy for acute myocardial infarction. More widespread application of this therapy should be encouraged, given recent data that determined a beneficial effect of therapy on mortality for patients presenting 6 to 12 hours after symptom onset. Failure to reperfuse following thrombolysis and infarct vessel reocclusion are significant shortcomings of the currently used thrombolytic agents and must be addressed by new agents and combination strategies. Identifying appropriate surrogate endpoints to assess new thrombolytic agents is mandatory because continued testing of all new agents through megatrials is not feasible. This paper examines the appropriate use of thrombolytic therapy, the limitations of and recent advances in existing therapy, and approaches to the evaluation of future thrombolytic regimens.