THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract

It is reported that the implementation in clinical practice thrombolytic (fibrinolytic) therapy resulted inmortality reduction during firstmonth after myocardial infarction from 17-18% to 5-8%. Different details of this therapy are considered: terms of thrombolysis since the beginning of myocardial infarction, alternative methods of coronary blood flow recovery , indications and contraindications, complications and side effects, estimation of thrombolysis efficacy. Fibrin-selective and fibrin-non-selective drugs are presented. Different fibrinolytics are described: streptokinase, anistreplase, alteplase, reteplase, tenekteplase. The results of large randomized clinical trials devoted to fibrinolytic therapy of myocardial infarction are analyzed: GISSI, ISSIS, TIMI, GUSTO, INJECT, ASSENT. The possibility to increase in efficacy and safety of fibrinolytics by their combination with acetylsalicylic acid, IIb/IIIa receptor inhibitors and heparins are discussed.

Keywords

• myocardial infarction
• thrombolysis
• fibrinolytics
• streptokinase
• anistreplase
• alteplase
• reteplase
• tenekteplase