• J L López-Sendón.
• Unidad Coronaria, Hospital La Paz, Universidad Autónoma, Madrid.
• Rev Esp Cardiol. 1992 Jan 1;45 Suppl 2:9-20.

AbstractThrombolytic therapy has prove to be effective to recanalize the occluded coronary artery in patients with acute myocardial infarction, reducing infarct size, preserving ventricular function and improving short and long term survival. In a number of studies the relative efficacy of the available thrombolytic agents has been studied an are discussed in this revision of the comparative, randomized trials. Some differences have been found in the relative efficacy of streptokinase, APSAC, urokinase and tPA to recanalized the occluded infarct related coronary artery. Reocclusion is probably highest with tPA and lowest with urokinase or the combination of urokinase and tPA. No differences were found in the reduction of infarct size and improving of left ventricular function. The mortality rate of patients treated with streptokinase, APSAC or tPA was found to be similar in two multicentric studies: GISSI-2 and ISIS-3. Major complications related with the use of thrombolytics include systemic or cerebral haemorrhage, allergic reactions, hypotension and probably heart rupture. Systemic and cerebral hemorrhages are more frequently associated with the use of tPA and APSAC than with streptokinase. Allergic reactions are more frequent after administration of streptokinase and APSAC than after tPA or urokinase and the same occurs with hypotension requiring treatment. The analysis of the available data from the comparative studies do not offer enough clinical evidence to consider any of the thrombolytic agents as the drug of choice in most patients with acute myocardial infarction.

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