CURRENT AND FUTURE PERSPECTIVES ON ANTITHROMBOTIC THERAPY OF ACUTE MYOCARDIAL-INFARCTION

Randomised trials of coronary artery patency and mortality support the routine use of antithrombotic therapy in all patients with suspected acute myocardial infarction. At present, it is unclear whether antipla telet therapy with aspirin alone will suffice or the addition of antic oagulation with either heparin or the newer specific thrombin inhibito r, hirudin, will confer a net benefit. The ongoing randomized trials, such as GUSTO-2 and TIMI-9, will provide relevant information on the u se of aspirin plus heparin or aspirin picks hirudin in patients heated with thrombolytic therapy. The First American study of Infarct surviv al (ASIS-1) will provide data which are relevant to the large populati on of patients who, in the United States, do not receive thrombolytic therapy. When these data become available it will be possible for clin icians to make rational individual decisions and policy-makers to form ulate guidelines concerning optimal antithrombotic therapy in myocardi al infarction.