New approaches to the management of AMI: Fibrinolysis plus GP IIb/IIIa receptor blockade

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.