Antiplatelet drugs plus thrombolysis in myocardial infarction: where are we now?
A breakthrough in platelet inhibition was achieved with the advent of antagonists of the glycoprotein (GP) IIb/IIIa receptors. These receptors are essential to platelet aggregation triggered by any of several different mechanisms. GP IIb/IIIa receptor antagonists, especially the monoclonal antibody abciximab, have been established as adjuncts to angioplasty in acute coronary syndromes. Conjunctive treatment with thrombolysis in myocardial infarction has been studied less extensively. GP IIb/IIIa receptor antagonists appear to be a feasible adjunct to thrombolysis. In particular, the use of abciximab in conjunction with reduced doses of thrombolytics is an attractive approach to achieve early coronary reperfusion with probably acceptable bleeding risk. The eventual role of this combined treatment can only be defined by the large-scale clinical trials that will be performed in the near future.
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Medizinische Klinik II, Stadtische Kliniken Kassel, Kassel, Germany.