Thrombolytic therapy of acute myocardial infarction

Considering the enormous increase in the use of thrombolytic therapy over the last decade, many of the early concepts of thrombolytic therapy have proved to be remarkably robust. Early and sustained restoration of coronary patency remains the ultimate goal. Streptokinase is still extensively used despite evidence that alteplase may, under some conditions, be more effective. Aspirin is of proven efficacy, heparin is important with alteplase but less so with streptokinase. The benefits of early thrombolysis, even if this means pre-hospital administration, have been repeatedly confirmed. On the debit side, more effective thrombolysis seems to go hand in hand with increased bleeding risk, and primary angioplasty seems to be emerging as a viable alternative in high risk patients. More effective regimens tend to be more complex, and the proportion of eligible patients receiving thrombolytic therapy is still relatively low. Better early diagnosis, by methods independent of the electrocardiogram, and simplified but effective treatment regimens using improved thrombolytic agents are likely developments in the near future.