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Overview of thrombolytic therapy in acute myocardial infarction
Suppl.
VII,
1987
THROMBOSIS RESEARCH
65
50
OVERVIEW OF THROMBOLYTICTHERAPY IN ACUTE MYOCARDIALINFARCTION. Sol Sherry, M.D. The Department of Medicine and the Thrombosis Research University School of Medicine, Philadelphia, PA, U.S.A.
Centre,
Temple
After many years of investigation, we are about to enter the “thrombolytic era” for the immediate treatment of all eligible patients with an acute evolving myocardial infarction. The events which have led us to this point include : 1) unequivocal establishment of an acute coronary thrombosis as the precipitant cause of almost all myocardial infarctions; 2) better understanding of the process of infarction, i.e. the initial “shocking” of the affected myocardium with reversible loss of function, followed by irreversible necrosis spreading from the endocardial to the epicardial surface; 3) knowledge of the speed of the process, i.e. in the absence of an effective collateral circulation, deleterious changes begin within 20 minutes of the ischemic event and are usually completed with 4-6 hours; 4) demonstration that when thrombolytic agents are given in adequate amounts within the first 3 hours of the onset of the ischemic event, rapid reperfusion of the occluded coronary artery can be accomplished in the majority of cases; evidence that thrombolytic agents administered intravenously 5) within the first 3 hours are as effective in lysing thrombi as can be accomplished through intracoronary delivery; 6) confirmation that the earlier the administration of thrombolytic drugs, the greater is the salvage of myocardium otherwise destined to necrose and the greater is corroboration that bleeding reduction in mortality; 7) the complications can be minimized by proper case selection, avoidance of invasive procedures and delayed initiation of anticoagulation; and 8) development of more effective methods for limiting rethrombosis. All of the agents under investigation have proven to be equally effective in mediating thrombolysis when used within the first 3 hours, but each has its advantages and disadvantages. In this respect, the novel drug Eminase (anisoylated plasminogen-streptokinase activator has many appealing features. the subject of this symposium, complex),
VII,
1987
THROMBOSIS RESEARCH
65
50
OVERVIEW OF THROMBOLYTICTHERAPY IN ACUTE MYOCARDIALINFARCTION. Sol Sherry, M.D. The Department of Medicine and the Thrombosis Research University School of Medicine, Philadelphia, PA, U.S.A.
Centre,
Temple
After many years of investigation, we are about to enter the “thrombolytic era” for the immediate treatment of all eligible patients with an acute evolving myocardial infarction. The events which have led us to this point include : 1) unequivocal establishment of an acute coronary thrombosis as the precipitant cause of almost all myocardial infarctions; 2) better understanding of the process of infarction, i.e. the initial “shocking” of the affected myocardium with reversible loss of function, followed by irreversible necrosis spreading from the endocardial to the epicardial surface; 3) knowledge of the speed of the process, i.e. in the absence of an effective collateral circulation, deleterious changes begin within 20 minutes of the ischemic event and are usually completed with 4-6 hours; 4) demonstration that when thrombolytic agents are given in adequate amounts within the first 3 hours of the onset of the ischemic event, rapid reperfusion of the occluded coronary artery can be accomplished in the majority of cases; evidence that thrombolytic agents administered intravenously 5) within the first 3 hours are as effective in lysing thrombi as can be accomplished through intracoronary delivery; 6) confirmation that the earlier the administration of thrombolytic drugs, the greater is the salvage of myocardium otherwise destined to necrose and the greater is corroboration that bleeding reduction in mortality; 7) the complications can be minimized by proper case selection, avoidance of invasive procedures and delayed initiation of anticoagulation; and 8) development of more effective methods for limiting rethrombosis. All of the agents under investigation have proven to be equally effective in mediating thrombolysis when used within the first 3 hours, but each has its advantages and disadvantages. In this respect, the novel drug Eminase (anisoylated plasminogen-streptokinase activator has many appealing features. the subject of this symposium, complex),