Current thrombolytic regimens improve survival of patients with acute myoca
rdial infarction but have shortcomings, including inadequate rates of compl
ete reperfusion, reocclusion after clot lysis, and bleeding complications.
Genetically engineered mutants of tissue-plasminogen activator (t-PA) can b
e administered by bolus rather than infusion. These newer agents have not s
hown definitive clinical improvements over t-PA, but they have practical an
d economic advantages and the potential to reduce medication errors. Platel
et glycoprotein (GP) IIb/IIIa receptor inhibitors, a class of potent antipl
atelet agents, are successful in treating patients with acute coronary synd
romes both within and outside the catheterization laboratory. The combinati
on of thrombolytic agents with GP IIb/IIIa inhibitors has produced encourag
ing results in pilot phase-ii dose-ranging and angiographic trials. Combina
tion therapy has produced higher Thrombolysis in Myocardial Infarction (TIM
I) 3 flow rates than either therapy alone. Optimal benefits, including mean
ingful reductions in bleeding complications, depend on further refinements
to the doses of both thrombolytics and the adjunctive heparin regimens used
in combination therapy.