Update on intravenous fibrinolytic therapy for acute myocardial infarction

Intravenous fibrinolytic therapy is used widely in the treatment of ST-elev ation acute myocardial infarction, Advances in this therapeutic modality du ring the past 5 years include new third-generation fibrinolytic agents and creative strategies to enhance administration and efficacy of fibrinolytic therapy. Several of the new agents allow for single- or double-bolus inject ion. A number of ongoing large randomized trials are attempting to determin e whether the combination of fibrinolytic therapy with low-molecular-weight heparin or a glycoprotein IIb/IIIa antagonist enhances coronary reperfusio n and reduces mortality and late reocclusion. One large prospective trial i s investigating the potential benefit of prehospital administration of fibr inolytic therapy, This article summarizes recent safety and efficacy data o n fibrinolytic therapy, with particular emphasis on the new third-generatio n fibrin-specific agents; reviews the preliminary data on facilitated fibri nolysis; and discusses the rationale for prehospital administration of fibr inolytic therapy.