[Strategies to improve reperfusion with fibrinolytic therapy in ST-T elevation myocardial infarction].
The main targets in reperfusion strategies in early ST-T elevation acute myocardial infarction phase are to improve and sustain tisular perfusion. Due to its accessibility and effectiveness in reducing myocardial damage and mortality, fibrinolytic therapy has been considered as the standard treatment. The most serious fibrinolytic therapy dilemma is the high failure and reocclusion rate, secondary to resistance and rethrombosis phenomena. In ST-T elevation acute myocardial infarction, therapy fibrinolytic in combination with aspirin could be considered the most important treatment advance. In the injury vascular setting, thrombosis induced by thrombin and platelet aggregability is the responsible mechanism and could limit the effectiveness of fibrinolytic therapy. The current knowledge of coronary thrombus physiopathogenesis establishes the limitations of fibrinolytic therapy in the achievement of optimal lysis, and suggests the necessity of antithrombotic and reperfusion strategy combination. Through this synergism it is feasibly to modify thrombus components improving efficiently. The propose of this review is to deeply analyze the fibrinolytic therapy resistance mechanisms, the modern approach to improve tisular perfusion, including accelerated fibrinolytic regimens, facilitated fibrinolysis, low molecular weight heparin experience and the role of new antithrombotic drugs, that has proved effectiveness in non-ST elevation acute myocardial syndromes treatment.
Jerjes-Sánchez
Carlos
C
Servicio de Urgencias, Hospital de Enfermedades Cardiovasculares y del Tórax No 34, Centro Médico del Norte, IMSS, Monterrey, Nuevo León. Av. San Angel 130 Depto 5, Col. Valle de San Angel CP 66290, San Pedro Garza García, NL. jerjes@infosel.net.mx
Sosa del Angel
Edgar
E
García Sosa
Anabel
A
Reyes Cerezo
Esteban
E
Garza Ruiz
Angel
A
D002986:Clinical Trials as Topic; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D017211:Treatment Failure
D005343:Fibrinolytic Agents