Thrombolytic therapy in acute myocardial infarction

Thrombolytic therapy represents the major advancement for the treatment of acute myocardial infarction (MI) that has been achieved in recent years. Based on the recognition of acute totally occlusive intracoronary thrombosis as the primary cause of ST-elevation MI, thrombolytics were evaluated alone or in combination with antithrombotics for the treatment of acute MI. Streptokinase, APSAC and t-PA were the first "standard" regimens evaluated. The "accelerated" t-PA infusion was introduced as the "gold standard" thrombolytic regimen with the GUSTO trial, and was administered in combination with aspirin and intravenous heparin. Many newer thrombolytics have been developed with the expectation to further decrease acute MI mortality, to decrease bleeding complications or to facilitate drug administration. The introduction of platelet glycoprotein IIb/IIIa inhibitors in clinical pharmacology has added a novel drug category for potential use for primary thrombolysis or in combination with thrombolytics. Conceptualizing thrombolytic and anti-thrombotic combination regimens will optimize treatment of acute MI in the future.