Summary
Pharmacologic reperfusion of patients with acute ST segment elevation myocardial infarction
is designed to achieve prompt high-quality reperfusion, prevent recurrent ischemia
and reinfarction, maintain long-term patency, and to enhance patient survival and
quality of life. Because monotherapy with fibrinolytics is by itself unable to achieve
all of these objectives, antithrombotic, anti-platelet, and other novel agents are
required. We discuss herein the role of unfractionated and enoxaparin, the potential
added value of direct thrombin inhibitors, and the importance of aspirin. Despite
the promise of glycoprotein IIb/IIIa inhibitors, risks associated with intracranial
hemorrhage in the elderly have led to restraint in their application to broad populations.
Facilitation of urgent percutaneous coronary intervention with combination reduced-dose
fibrinolytic and glycoprotein IIb/IIIa inhibitors remains a promising potential future
path. The future is likely to emphasize greater application of the already effective
therapies at our disposal and the development of novel anti-platelet and anti-thrombin
agents as well as those directed toward inflammation.
Keywords
Clinical trials - fibrinolytic therapy - clinical trials - heparins / LMWH