OPTIMIZING THROMBOLYTIC TREATMENT IN ACUT E MYOCARDIAL-INFARCTION - ROLE OF NEW AGENTS AND THEIR ASSOCIATION WITH NEW ANTITHROMBOTIC THERAPIES

Although reperfusion therapy is well recognized as the mainstay of tre atment of acute myocardial infarction, mortality of myocardial infarct ion is still high, thrombolytic treatment remains underutilized and, u sually, applied too late. Additionally, most of the patients do not ex perience optimal reperfusion because of the suboptimal flow rate in th e infarct-related artery, abnormal microvascular flow, and reocclusion of the infarct-related artery. Strategies to enhance the results of r eperfusion therapy include, expanding the population of potential cand idates, earlier treatment, and newer methods to improve infarct-relate d artery now rates. In this sense, new thrombolytic agents, and combin ation therapies with or without addition of more potent and specific n ew antithrombotic agents are being extensively investigated. Also, it is important to promote studies of ancillary treatments to reduce repe rfusion injury, which may be one cause of decreased microvascular flow . Although aspirin and heparin have been the conventionally used agent s for inhibiting thrombin and platelet function, newer agents such as hirudin or hirulog and inhibitors of the platelet glycoprotein IIb-III a receptors are becoming available, and their clinical application wil l increase in the future.