Current concepts in coronary thrombolysis

It has become increasingly apparent that the success of coronary thrombolysis depends on a dynamic balance between fibrinolytic and procoagulant activity. The differential properties of specific plasminogen activators determine the rate at which clot lysis is induced, the extent to which procoagulant activity and platelet activation are increased, and the extent to which recurrent thrombosis is inhibited. Current conjunctive regimens (aspirin and heparin) appear to attenuate but not preclude recurrent thrombosis in patients treated with coronary thrombolysis. The recent development of a variety of new anticoagulants with different mechanisms of action may result in even more effective treatment strategies. Whether these newer agents will result in improved survival in patients treated with coronary thrombolysis without compromising safety will need to be established by clinical trials.