[Thrombolysis in unstable angina. A perspective before and after TIMI IIIB]

To identify the utility and security of thrombolytic therapy in unstable angina, we performed: a) retrospective analysis of controlled trials through computers system and cross references; b) analysis of TIMI IIIB trial to identify variables that explain, why thrombolytic therapy was unsuccessful; c) analysis of our clinical experience. For the three models of research, variables of primary and secondary effectivity were designed. Twenty two controlled trials with 3,544 patients were analyzed, the variables of primary effectivity suggest that in patients with unstable angina with sustained and recurrent clinical and electrocardiographic manifestations of acute ischemia, the use thrombolytic therapy could produce benefit, if the main mechanism is an intracoronary thrombus and if it is associated with maximum pharmacologic treatment and anticoagulation in acute phase. In the TIMI IIIB trial, variables that explain unsuccessful thrombolytic therapy were identified. The clinical experience in 17 patients with high risk unstable angina that received streptokinase in accelerated and standard infusion, proved success in 100% of the cases by improvement of ischemia, avoidance of infarction and recurrence, without hemorrhagic complications, without mortality. The results suggest, that in unstable angina with high clinical suspicion of disruption and thrombogenesis, refractory acute ischemia, jeopardized myocardium, and hemodynamic unstability, thrombolytic therapy could be an alternative that eliminates acute ischemia, as a bridge to the use in a second time of a definitive therapy. These data require in our environment revalidation with controlled trials and inclusion of more patients.