Acute myocardial ischemia and infarction: Making the right decisions in antithrombotic and reperfusion therapies

Acute coronary syndromes, which include unstable angina and myocardial infa rction (MI), have the common pathophysiological mechanism of intracoronary thrombus formation. Treatment of an acute MI initially focuses on reperfusi on with thrombolysis or percutaneous coronary interventions (PCI)s, Primary or direct percutaneous interventions, with traditional angioplasty and ste nting, appear to provide superior efficacy for acute MI, although temporal factors are crucial. However, antiplatelet and antithrombin therapies are a lso vital for the maintenance and enhancement of complete coronary perfusio n and for primary management of non-Q wave myocardial infarction (NQWMI) an d unstable angina. Recent advances in the pharmacological treatment include the use of direct thrombin inhibitors, low-molecular-weight heparin, and g lycoprotein IIb/IIIa antagonists, all of which have shown substantial benef it for acute coronary syndromes. The article focuses on the clinical litera ture supporting the utility of recent therapeutic advances and outlines the current indications for such treatments.