Thrombolytic and antithrombotic treatment in myocardial infarction: main achievements and future perspectives

Several trials enrolling thousands of patients have demonstrated the beneficial effect of thrombolytic therapy on survival in patients with acute myocardial infarction. Three large trials have compared the effect of different thrombolytic agents on mortality from myocardial infarction: GISSI-2/International trial, ISIS-3, and GUSTO. In this last trial, treatment with accelerated t-PA and intravenous heparin resulted in a 14% relative reduction in mortality compared with streptokinase and intravenous or subcutaneous heparin. The results of the GUSTO trial renewed the interest toward new strategies for enhancing the speed and rate of coronary reperfusion. An improvement in coronary patency can be anticipated by adopting a variety of pharmacological approaches that include the development of more effective therapeutic regimens with the available thrombolytic agents, the development of more fibrin specific agents and the development of safer and more effective adjunctive antithrombotic agents to accelerate thrombolysis and to prevent rethrombosis.