Acute Myocardial Infarction: Fibrinolytic Therapy

Fibrinolytic therapy (also known as thrombolytic therapy) is an established, simple, widely available and cost-effective treatment option for acute myocardial infarction. Adjunctive use of antiplatelet and antithrombin therapies has been shown to reduce reinfarction rates by 30% to 40%. These agents may also improve reperfusion rates and facilitate percutaneous coronary intervention (PCI). Adjunctive use of platelet glycoprotein IIb/IIIa inhibitors and newer antithrombotic agents (eg, low molecular weight heparin, bivalirudin, or pentasaccharide) has not been shown to reduce 30-day mortality rates. Bolus administration of fibrinolytic agents enhances their acceptability for prehospital use, and dose adjustment of antithrombotic therapy may help to reduce the risk of bleeding, particularly in lighter-weight patients and the elderly. There is a need for trials comparing newer fibrinolytic regimens with primary PCI and facilitated PCI. The time from symptom onset to reperfusion is the most important factor affecting patient outcome.