Acute myocardial ischemia and infarction: making the right decisions in antithrombotic and reperfusion therapies

Acute coronary syndromes, which include unstable angina and myocardial infarction (MI), have the common pathophysiological mechanism of intracoronary thrombus formation. Treatment of an acute MI initially focuses on reperfusion with thrombolysis or percutaneous coronary interventions (PCI)s. Primary or direct percutaneous interventions, with traditional angioplasty and stenting, appear to provide superior efficacy for acute MI, although temporal factors are crucial. However, antiplatelet and antithrombin therapies are also vital for the maintenance and enhancement of complete coronary perfusion and for primary management of non-Q wave myocardial infarction (NQWMI) and unstable angina. Recent advances in the pharmacological treatment include the use of direct thrombin inhibitors, low-molecular-weight heparin, and glycoprotein IIb/IIIa antagonists, all of which have shown substantial benefit for acute coronary syndromes. The article focuses on the clinical literature supporting the utility of recent therapeutic advances and outlines the current indications for such treatments.