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[Thrombolytic therapy in acute myocardial infarct]
1I. interná klinika Lekárskej fakulty Univerzity Komenského v Bratislave.
Insights
Thrombolytic therapy (TL) effectively treats acute myocardial infarction (AMI) by restoring blood flow and reducing mortality. Early administration of TL, particularly with drugs like alteplase (rt-PA), yields better outcomes and is not age-limited.
Area of Science:
- Cardiology
- Pharmacology
- Emergency Medicine
Background:
- Clinical studies demonstrate thrombolytic therapy (TL) benefits patients with acute myocardial infarction (AMI).
- TL aims to reperfuse ischemic areas, reduce infarct size, and decrease mortality.
- Timely TL administration within hours of AMI onset is crucial for optimal results.
Purpose of the Study:
- To review the efficacy and administration guidelines of thrombolytic therapy for acute myocardial infarction.
- To discuss the selection of thrombolytic agents and adjuvant therapies.
- To outline management strategies for complications such as severe bleeding.
Main Methods:
- Review of clinical data and studies on thrombolytic therapy for AMI.
- Analysis of different thrombolytic drugs including streptokinase (SK), anistreplase (APSAC), urokinase, and alteplase (rt-PA).
- Evaluation of adjuvant therapies like acetylsalicylic acid and heparin.
Main Results:
- All current thrombolytic drugs significantly reduce AMI mortality.
- Accelerated rt-PA is preferred over SK in younger patients with extensive anterior AMI within 4 hours of onset.
- Adjuvant antithrombotic therapy, especially heparin with rt-PA, improves TL outcomes.
Conclusions:
- Thrombolytic therapy is a cornerstone in AMI management, with early intervention being key.
- Drug selection and timing influence treatment effectiveness and complication management.
- Antithrombotic therapy, particularly heparin, plays a vital role in enhancing TL efficacy and preventing embolization.
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 occurrence of severe bleeding indicates that TL should be halted and coagulation factors should be replaced 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.)