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Updated: Jun 6, 2026

Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolytics and myocardial infarction
Vijayalakshmi Kunadian1, C Michael Gibson
1Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK.
Insights
Coronary artery disease (CAD) management has evolved significantly. Thrombolytic agents, from streptokinase to newer tissue plasminogen activators, improve survival in acute myocardial infarction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) is the leading cause of death in the US.
- Myocardial infarction (MI) is primarily caused by coronary artery occlusion.
Observation:
- Streptokinase, an early thrombolytic, reduced mortality in acute MI.
- Development of newer tissue plasminogen activators (tPAs) like alteplase, reteplase, and tenecteplase followed.
Findings:
- Thrombolytic therapy has significantly reduced cardiovascular mortality.
- Primary percutaneous coronary intervention is a key management strategy.
Implications:
- Modern management of acute MI involves thrombolytic agents and percutaneous coronary intervention.
- These advancements have revolutionized patient outcomes and survival rates.
Abstract:
Coronary artery disease is the single leading cause of death in the United States. Occlusion of the coronary artery was identified to be the cause of myocardial infarction almost a century ago. Following a series of investigations, streptokinase was discovered and demonstrated to be beneficial for the treatment of patients with acute myocardial infarction in terms of reducing short- and long-term mortality. Newer agents including tissue plasminogen activators such as alteplase, reteplase, tenecteplase were developed subsequently. In the present era, thrombolytic therapy and primary percutaneous coronary intervention has revolutionized the way patients with acute myocardial infarction are managed resulting in significant reduction in cardiovascular death. This article provides an overview of the various thrombolytic agents utilized in the management of patients with acute myocardial infarction.
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