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[In Process Citation]
1I. interna klinika Lekarskej fakulty Univerzity Komenskeho v Bratislave, Slovakia.
Insights
Thrombolytic therapy (TL) effectively treats acute myocardial infarction (AMI) by improving reperfusion and reducing mortality. Early administration of TL, particularly with drugs like alteplase (rt-PA), yields better outcomes, with careful management of bleeding risks and adjuvant therapies.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Thrombolytic therapy (TL) is a cornerstone treatment for acute myocardial infarction (AMI).
- Clinical data demonstrate TL's favorable effects on reperfusion, infarct size reduction, and mortality.
- Optimal timing and drug selection remain critical for maximizing TL efficacy.
Purpose of the Study:
- To review the current understanding and application of thrombolytic therapy in acute myocardial infarction.
- To discuss the benefits, drug choices, and management strategies associated with TL for AMI.
Main Methods:
- Review of clinical data and studies on thrombolytic therapy for AMI.
- Analysis of different thrombolytic agents, including streptokinase (SK), anistreplase (APSAC), urokinase, and alteplase (rt-PA).
- Evaluation of adjuvant antithrombotic therapies and management of complications like severe bleeding.
Main Results:
- TL significantly decreases mortality in patients with AMI.
- Early administration of TL (within hours of onset) improves outcomes.
- Alteplase (rt-PA) is preferred for extensive anterior wall AMI in younger patients within 4 hours.
- Management of severe bleeding involves halting TL and replacing coagulation factors; antifibrinolytics can manage SK-induced bleeding.
- Adjuvant antithrombotic therapy, including heparin with rt-PA, improves TL results.
Conclusions:
- Thrombolytic therapy is a vital treatment for acute myocardial infarction, offering significant survival benefits.
- Drug selection and timing are crucial, with rt-PA showing advantages in specific patient groups.
- Careful management of bleeding complications and the judicious use of adjuvant therapies are essential for optimizing patient outcomes.
Abstract:
The data gained from clinical studies in the past years have indicated that the thrombolytic therapy (TL) has favourable effect on patients with acute myocardial infarction (AMI). It is aimed at reperfusion in the ischaemic area, a decrease in the extent of infarction site and a decrease in mortality. TL administered within the initial hours after the onset of AMI leads to better results than when administered after several hours. Currently, TL is not limited by age. The patients who were given streptokinase (SK) or anistreplase (APSAC) prior to more than 4 days, if necessary, urokinase or alteplase (rt-PA) should be given. There are differences in the opinions as to the optimal selection of thrombolytic drugs. However, all currently used drugs lead to a significant decrease in mortality due to AMI. The preferential use of accelerated administration of rt-PA in contrast to SK is justified in younger patients with extensive AMI of the anterior wall, in whom the therapy has begun within 4 hours since its onset. The occurence of severe bleeding indicates that TL should be halted and coagulation factors should be replaces by freshly frozen plasma or fibrinogen concentrate, if necessary, transfusion of full blood should take place. If the severe bleeding occurs shortly after the administration of SK, the persisting plasminaemia can be arranged by antifibrinolytic drugs. An improvement in TL results can be achieved by adjuvant antithrombotic therapy. At the same time, in addition to acetylsalicylic acid, the patient treated with rt-PA should be given heparin. Heparin administration is not necessary in patients treated with SK or APSAC. However, heparin is indicated in patients at risk due to systemic embolization in congestive heart disease, extensive infarction or atrial fibrillation. (Tab. 1, Ref. 28).