[Which thrombolysis in myocardial infarction?]

Intravenous administration of thrombolytic agents in myocardial infarction is now preferred to the intracoronary route, which nonetheless is still used in some special indications. The dissolution of thrombi occurs at the same rate for the two routes of administration. The secondary reocclusion rate remains high and seems to be linked to the duration of action of the thrombolytic. The highest secondary reocclusion rates are seen with short-acting thrombolytics such as plasminogen activator. Anticoagulant therapy using heparin is used extensively in prevention of secondary reocclusion. Antiplatelet drugs, nonsteroidal anti-inflammatories and prostacyclin analogs are currently being evaluated. All thrombolytics currently used limit the size of subsequent infarction, preserve left ventricular systolic function and reduce mortality. All are equally likely to result in hemorrhagic complications, regardless of whether or not they are specific for fibrin. The role of complementary revascularization after successful thrombolysis is becoming clearer. No additional improvement in left ventricular function or the rate of secondary reocclusion is achieved by immediate angioplasty, and more complications are seen. For this reason coronary arteriography and complementary revascularization should probably be delayed for a few days after thrombolysis.