[Thrombolytic therapy in acute myocardial infarct in 1992]

The management of acute myocardial infarction has dramatically changed in the last decade. The conservative approach with bed rest, oxygen therapy, pain relief and prevention of complications--the former cornerstones of the treatment of acute myocardial infarction--are now being replaced with new, more aggressive forms of therapy, including early administration of thrombolytic agents. With the more than 100,000 patients studied in various clinical trials in the different parts of the world, the use of thrombolytic therapy is probably the most thoroughly studied medical intervention in human medical history. The results of these trials undoubtedly showed that thrombolytic therapy had a major impact on reducing mortality and preserving left ventricular function in patients with acute myocardial infarction. The purpose of this article is to review current new information on thrombogenesis and thrombolysis, the indications and contraindications of thrombolytic therapy, comparisons between different thrombolytic agents and the role of adjuvant antithrombotic therapy.