[The management of postthrombolysis patients]

Early reperfusion with thrombolytic therapy in acute myocardial infarction results in myocardial salvage. However, it is apparent that patients remain at substantial risk for vascular reocclusion and residual ischemia (either peri-infarct or at a distance). Vascular reocclusion is promoted by local factors (residual thrombus, high shear rate, exposure of deep arterial tissues) as well as by systemic factors (activation of platelets and coagulation factors). Reocclusion after thrombolysis is significantly prevented by aspirin and intravenous heparin but not by coronary angioplasty. Neither recurrent myocardial infarction nor left ventricular dysfunction are favourably affected by coronary angioplasty which, together with coronary by-pass surgery, should be considered only in case of documented recurrent ischemia. The well-acknowledged role of beta-blockers after myocardial infarction holds true even after thrombolytic therapy, since this treatment decreases the occurrence of new ischemic events. The process of left ventricular remodeling after myocardial infarction is presently investigated and a positive effect has been shown in patients with large myocardial infarction being treated with converting-enzyme inhibitors and/or nitrates. The results of large-scale clinical trials currently underway are eagerly awaited.