A marriage of enhancement: fibrinolysis and conjunctive therapy.
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.
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