CURRENT CONCEPTS IN CORONARY THROMBOLYSIS

Thrombolytic therapy has become standard care in treating acute myocar dial infarction. Fibrinolytic drugs such as streptokinase, APSAC and u rokinase are non fibrin specific, and induce systemic activation of th e fibrinolytic process, while t-PA and prourokinase are fibrin specifi c since they are able to activate mainly fibrin bound plasminogen. Bot h groups of thrombolytics exert different and opposing effects on the hemostatic balance: indeed, they have antithrombotic as well as prothr ombotic properties, and this may be important for explaining therapeut ic failures or reocclusions. New strategies have been considered or ar e under investigation for further improving the already excellent effi cacy of thrombolytic treatment in myocardial infarction: combined admi nistration of fibrinolytic agents, thrombus-targeted thrombolytic drug s, association with other drugs both effective and ineffective on the hemostatic process. At present, however, the first priority still Seem s to be a continuing effort to increase the percentage of patients tre ated with thrombolytics, since the benefits of this therapy have alrea dy been clearly demonstrated.