title: Future of thrombolytic therapy--an Indian context.
abstract: Acute myocardial infarction has two main treatment modalities in the form of direct angioplasty (PAMI) and intravenous thrombolysis. PAMI is statistically clearly superior to intravenous thrombolysis. However, as ground reality in Indian conditions PAMI remains a distant ideal option for many ST elevation MI patients. In order to bridge the gap between IV thrombolysis and PAMI, early/pre-hospital IV thrombolysis to all and early angiography within 3 to 24 hours is the treatment modality, which needs to be exercised in India. Because of the encouraging results of pharmaco-invasive treatment in acute and long-term morbidity and mortality, it should be the prime treatment of management of ST elevation myocardial infarction in India. The future of IV thrombolysis will remarkably be based on whether Indian physicians switch to direct Fibrin Inhibitors like Tenectaplase and Reteplase and whether every patient of ST elevation MI undergoes early angiography or not. If these two changes are accepted for treatment of ST elevation MI, remarkably successful and effective treatment could be offered in a place like India, which is too vast and too diversioned and too socio-economically irrelevant for the ideal treatment of PAMI. In conclusion, early/pre-hospital thrombolysis with Tenectaplase/Retelase and angiography within 3 to 24 hours is the way to go in future in India.
authors.affiliation: Poona Hospital.
authors.forename: J S
authors.initials: JS
authors.lastname: Hiremath
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016507:Cardiology Service, Hospital / Q000639:trends*; D017023:Coronary Angiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007194:India; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents