[Thrombolysis in acute myocardial infarct. An established therapy with open questions]

Intravenous thrombolysis is an established form of therapy within the first 4-6 hours of acute myocardial infarction. In numerous randomized controlled trials it has been shown to be effective in restoring myocardial perfusion, reducing mortality and improving ventricular function. The data so far available do not allow conclusions regarding the best lytic substance. The complication rate is surprisingly low. As adjunctive therapy, aspirin exerts an additive effect and heparin should be given for the first 48 hours. Its exact role is still under investigation. Several ongoing studies are designed to answer the remaining questions: (1.) Which patients with symptoms of more than 6 hours' duration could benefit from thrombolysis? (2.) Should patients with unstable angina be given this treatment? (3.) To minimize delay, it might be beneficial to start thrombolysis in the prehospital phase, but the problems of information and organization need to be solved. (4.) Attempts are being made to further improve thrombolytic and adjunctive therapy.