[The future of fibrinolysis: from fibrinolytic treatment to reperfusion therapy].
Fibrinolytic therapy is aimed at dissolving the fibrin clot. Its use now represents the optimal therapy for an acute evolving myocardial infarction. Although improved fibrinolytic agents are now being developed, the next frontier appears to be thrombolytic therapy which will combine fibrinolysis to platelet active drugs and specific inhibitors of blood coagulation, targetting the blood clot formation process itself. The most promising agents in this regard are inhibitors of the platelet glycoprotein IIb-IIIa receptors and specific thrombin inhibitors active on clot bound thrombin. This should result in more complete control of the thrombogenicity of the culprit coronary artery lesion. The comprehensive approach for the management of acute myocardial infarction should however ultimately be reperfusion therapy combining to thrombolytic therapy measures that will preserve the acutely ischemic myocardium and prevent the long-term deleterious effect of infarct expansion and left ventricular remodelling.
Théroux
P
P
Montreal Heart Institute, Quebec, Canadá.
D001241:Aspirin / Q000008:administration & dosage; D001779:Blood Coagulation Factors / Q000037:antagonists & inhibitors; D002801:Cholinesterase Reactivators / Q000008:administration & dosage; D002863:Chromogenic Compounds / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003931:Diacetyl / Q000008:administration & dosage / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007263:Infusions, Parenteral; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion; D010980:Platelet Membrane Glycoproteins / Q000187:drug effects; D013917:Thrombin / Q000037:antagonists & inhibitors; D015912:Thrombolytic Therapy
D001779:Blood Coagulation Factors; D002801:Cholinesterase Reactivators; D002863:Chromogenic Compounds; D006629:Hirudins; D010980:Platelet Membrane Glycoproteins; C004717:diacetylmonoxime; D013917:Thrombin; D003931:Diacetyl; D001241:Aspirin
El futuro de la fibrinólisis: del tratamiento fibrinolítico a la terapéutica de reperfusión.