Update on Strategies to Improve Thrombolysis for Acute Myocardial Infarction

Abstract

Therapy for acute myocardial infarction involves rapid restoration of blood flow through a coronary artery that has been occluded by a ruptured atherosclerotic plaque. Thrombolytic therapy, the pharmacologic standard to achieve this outcome, significantly improves survival; however, current regimens have limitations: they can fail to achieve complete reperfusion, they can cause significant bleeding events, and they can result in reocclusion. In addition, complex regimens of some agents can cause dosing errors. Accordingly, newer compounds were developed to address some of these issues, and alternative strategies are being implemented. The combination of platelet glycoprotein IIb-IIIa receptor inhibitors plus thrombolytic agents produced promising results in clinical trials, including faster clot lysis and greater flow rates than either therapy alone. The addition of unfractionated heparin or low-molecular-weight heparin to thrombolytic-antiplatelet therapy is being evaluated, as is administration of thrombolytic-antiplatelet before percutaneous coronary intervention.

Therapeutic Potential of Monteplase in Acute Myocardial Infarction as a Powerful Thrombolytic Agent for Pretreatment of Coronary Intervention

“…Monteplase is a potent agent that can be administered as a single intravenous Cardiovascular Drug Reviews, Vol. 22 Baseline PAI-1 level and patency of infarct-related artery prior to PCI in both patient groups (direct PCI and PCI following monteplase). In both groups, the baseline PAI-I levels were higher in patients who did not have TIMI 3 flow at the initial coronary angiography.…”

“…Recently, new thrombolytic agents have been developed, including constructs of mutants from plasminogen activators. These mutant tissue type-plasminogen activators (mt-PA) have high thrombolytic potency, slower clearance compared with rt-PA, and are potentially useful in the clinical setting (22). However, there have been only a few published reports on clinical trials with mt-PAs.…”

“…22 14 (8)(9)(10)(11)(12) 32 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) monteplase and PCI. For early patency monteplase or another thrombolytic agent should be administered on arrival at a community hospital followed by prompt transfer of the patients to a tertiary center for PCI.…”