Have we reached the therapeutic ceiling in acute myocardial infarction?

Despite the recent introduction of several new agents into the fibrinolytic market, none have proven more efficacious than earlier agents. However, new routes of administration may provide some benefit in terms of time to treatment and ease of administration. The best possibility for breaking the therapeutic ceiling is in finding new ways to use fibrinolytic agents, such as combination therapy with GP IIb/IIIa inhibitors and low-molecular-weight heparin. Use with PCI may decrease mortality rates in some patient groups. Prehospital administration of fibrinolytics is also an option for expediting care and improving outcomes.