Thrombolytic Therapy in Acute Myocardial Infarction

Abstract

Early thrombolytic therapy has been shown to reduce hospital mortality after myocardial infarction by 20-50%. This is achieved through reperfusion of the ischemic myocardium, which leads to limitation of infarct size by 15-30% and preservation of regional and global left ventricular function. Thrombolysis and reperfusion can be achieved by intravenous administration of streptokinase, urokinase, APSAC, or rt-PA, or by intracoronary administration of streptokinase or urokinase. Thrombolytic therapy is most effective in patients with extensive myocardial ischemia (large infarction) treated early after the onset of symptoms, but also patients with smaller infarcts may benefit from the therapy. It is uncertain whether treatment later than six hours after the onset of symptoms is beneficial, and if so, in which patients. Thrombolytic therapy leads to bleeding complications in a minority of patients. The risk of intracranial bleeding is approximately 0.5%. However, in several large trials the rate of cerebrovascular accidents (bleeding plus embolism) was not higher after thrombolytic therapy with streptokinase or rt-PA than after placebo. In order to prevent rethrombosis, additional treatment with acetyl salicylic acid and heparin is recommended. Nitrates and antiarrhythmic drugs are not recommended as routine practice. Immediate PTCA does not improve patient outcome. At present angiography and subsequent angioplasty or bypass surgery is recommended in patients with recurrent ischemia (spontaneous or upon exercise) after the infarct.

Microneedle system for tissue engineering and regenerative medicine

“…Cardiovascular disorders like myocardial infarction (MI) and ischemic myocardial disease, have become an intractable medical issue because of their high incidence and low curative rate. [ 77 ] The effective treatments to re‐establish the function of infarcted myocardial tissue include reperfusion therapy, [ 78 ] thrombolytic therapy, [ 79 ] and cellular therapy. [ 80 ] To date, stem cell‐based therapies are already applied for cardiac therapy and gained attention for their ability to promote injured heart regeneration.…”

“…[77] The effective treatments to re-establish the function of infarcted myocardial tissue include reperfusion therapy, [78] Reproduced with permission under a Creative Commons CC BY-NC License. [84] Copyright 2018, American Association for the Advancement of Science thrombolytic therapy, [79] and cellular therapy. [80] To date, stem cell-based therapies are already applied for cardiac therapy and gained attention for their ability to promote injured heart regeneration.…”

Thrombotic Changes in Haemostasis Following Intravenous Streptokinase Treatment for Acute Myocardial Infarction

“…D ear Sir, Throm bolytic treatm ent is now widely used in patients with acute myocardial infarction (AM I) to achieve coronary artery reperfusion and m aintenance of left ventricular function (1)(2)(3). Brief infusion of high dose streptokinase (SK) is a feasible treatm ent in almost all coronary units and hospitals that care patients with A M I (4).…”

Pharmacokinetics of a Slower Clearing Tissue Plasminogen Activator Variant, TNK-tPA, in Patients with Acute Myocardial Infarction

“…Thrombolytic therapy represents a major advance in the treatment of acute myocardial infarction that significantly reduces morbidity and mortality (1). Early administration of thrombolytic therapy in acute myocardial infarction achieves patency in the infarct-related artery and can improve survival (2).…”