Thrombolytic therapy in acute myocardial infarction

Total coronary occlusion by thrombus has been shown to be the causative factor in acute transmural myocardial infarction and early reperfusion has been shown to result in salvage of jeopardized myocardium. Over the last several years, large randomized trials have demonstrated the life-saving benefits of early administration of thrombolytic therapy. Two agents, streptokinase and rt-PA, are currently in use in the United States. Use of these agents requires a high degree of suspicion that the physician is actually treating an infarction and a careful screening of the patient for risk factors for serious hemorrhage. The use of adjunctive drugs with these agents as well as the timing of and indications for coronary arteriography and angioplasty are still under investigation.