[Optimal thrombolysis].
Thrombolytic therapy is an established reperfusion strategy in acute myocardial infarction with proven long-term survival benefit. New thrombolytic agents including reteplase, lanoteplase, and tenecteplase have been developed to optimize thrombolytic therapy. With respect to efficacy the new thrombolytic agents show mortality equivalent to front-loaded alteplase, the present gold standard of thrombolytic therapy. With respect to ease of application there are advantages because third generation agents can be given as a single or double bolus instead of a bolus followed by an infusion. The most promising strategy to optimize coronary thrombolysis seems to be the combination of thrombolytic agents in reduced dose and GP IIb/IIIa blockers in full dose. The corresponding clinical trials (TIMI-14, SPEED, and INTRO-AMI) have also shown that there is an evolution in the surrogate end points for an optimal thrombolysis. In the past, optimal thrombolysis was associated with an open infarct-related coronary artery. A few years ago it was realized that TIMI-3 flow in the epicardial coronary artery was associated with the best results. Presently, normal myocardial microcirculation is regarded an additional prerequisite for further reduced mortality in acute myocardial infarction.
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D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003326:Coronary Circulation; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D008833:Microcirculation; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; C081981:lanoteplase; C087896:reteplase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide; D000077785:Tenecteplase; D000077284:Abciximab