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Thrombolysis in unstable angina: results of clinical studies
D Scrutinio1, M G Biasco, P Rizzon
1Clinica del Lavoro Foundation, IRCCS, Bari, Italy.
Insights
Thrombolytic therapy for unstable angina remains controversial due to inconsistent results. Large trials are ongoing to clarify its role, but early thrombolysis may benefit select patients with severe rest angina and ischemic changes.
Area of Science:
- Cardiology
- Thrombosis Research
Background:
- Intracoronary thrombosis on disrupted plaques is key in unstable angina.
- Thrombolytic therapy is effective for acute myocardial infarction.
Purpose of the Study:
- To evaluate the role of thrombolytic treatment in unstable angina.
- To resolve the controversy surrounding thrombolysis for unstable angina.
Main Methods:
- Review of small-sized studies with inconsistent results.
- Ongoing large-scale, randomized, controlled trials (TIMI III, UNASEM).
Main Results:
- Previous studies yielded inconsistent and deceiving results.
- Current evidence is insufficient to definitively establish thrombolysis for unstable angina.
Conclusions:
- The role of thrombolysis in unstable angina is still debated.
- Early thrombolysis may be considered for severe rest angina with transient ST-T changes.
- Large trials are expected to provide definitive answers.
Abstract:
Ample evidence exists to support the major role of intracoronary thrombosis superimposed on a disrupted plaque in unstable angina. Consequently, thrombolytic treatment, already established to be highly beneficial in patients with acute myocardial infarction, might also be indicated in patients with unstable angina. The clinical response to thrombolytic treatment has been evaluated in several small-sized studies with inconsistent and somewhat deceiving results. Thus, the role of thrombolysis in the treatment of unstable angina is still controversial. Two ongoing large-scale, randomized, controlled trials, the Third Thrombolysis in Myocardial Infarction (TIMI III) in the United States testing recombinant tissue-type plasminogen activator and UNASEM in Europe testing anisoylated plasminogen-streptokinase activator complex will, it is hoped, solve the debate. At present, early thrombolysis might be considered for the treatment of the subset of patients with severe rest angina associated with transient ST-T ischemic changes.