[Thrombolysis in acute myocardial infarct].
The introduction of intravenous, high-dose thrombolytic therapy during a brief period has markedly reduced mortality of patients with acute myocardial infarction. While mortality can be reduced by any of the available thrombolytic agents that are applied within the first 24 hours following onset of chest pain, the effects on preservation of cardiac performance which can be achieved following application of thrombolytic therapy within four hours do markedly differ as a consequence of pharmacological properties and rate of early perfusion and patency between different agents. To preserve cardiac performance, rt-PA is the primary candidate to achieve early reperfusion and APSAC the one to prevent reocclusion. In contrast to these, the fibrin-unspecific thrombolytic agent, streptokinase, with its long fibrinolytic activity, seems to be the primary choice to achieve recanalization of vessels occluded by mixed and organized thrombus consisting of platelets and erythrocytes. Of particular importance is, that reocclusion has been prevented by administering an adjuvant therapy of aspirin and heparin. A number of questions are currently being studied and cannot be answered at this date: a) the majority of data does not support the use of a thrombolytic therapy in patients with unstable angina, b) there is no substantial benefit demonstrated in administering thrombolytic therapy prior to transportation of the patient to the hospital, c) the precise dosage of thrombolytic agents and of possible combinations, d) the putative impact of future antiplatelet drugs to further improve late patency.
Abteilung Kardiologie, Kantonsspital, Luzern.
P
P
Erne
D016255:Anistreplase / Q000627:therapeutic use; D005342:Fibrinolysis; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D016255:Anistreplase; D010959:Tissue Plasminogen Activator
Die Thrombolyse beim akuten Myokardinfarkt.