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Thrombin antagonists and antiplatelet agents.

¹Division of Cardiology, University of Massachusetts Medical School, Worcester 01655.

The American Journal of Cardiology

|January 3, 1992

Summary

Thrombolytic therapy for myocardial infarction faces challenges like clot resistance and reocclusion due to procoagulant activity. Newer, targeted agents show promise in overcoming these limitations.

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Area of Science:

Cardiovascular Medicine
Hematology
Pharmacology

Background:

Thrombolytic therapy is crucial for myocardial infarction but limited by resistant thrombi and reocclusion.
These issues stem from localized procoagulant activity at plaque rupture sites, involving thrombin and platelet activation.
Current treatments use heparin and aspirin but have limitations.

Purpose of the Study:

To review the limitations of current thrombolytic therapy for myocardial infarction.
To explore the role of procoagulant activity in thrombolytic resistance and reocclusion.
To discuss the potential of novel antithrombotic agents.

Main Methods:

Review of existing clinical evidence and experimental models.
Analysis of the mechanisms underlying thrombolytic resistance and reocclusion.
Evaluation of current and emerging therapeutic strategies.

Main Results:

20-25% of coronary thrombi resist lysis; 10-15% of patients experience reocclusion.
Heightened procoagulant activity, particularly thrombin and platelet activation, contributes significantly.
Heparin and aspirin improve outcomes but are not fully effective.

Conclusions:

More potent and selective agents targeting thrombin and platelets are needed.
Experimental models suggest specific thrombin antagonists and antiplatelet agents are superior to current therapies.
Further research is required to establish the safety and efficacy of these novel agents for widespread clinical use.

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