Zeitschrift für Kardiologie
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The benefits of coronary thrombolysis appear to depend primarily on achieving and maintaining coronary artery patency. Unfortunately, failure of coronary thrombolysis or recurrent occlusion may occur in up to 40% of patients treated with fibrinolytic agents. Results of recent studies suggest that recurrent thrombosis may be due to multiple factors including: plasmin-mediated activation of the coagulation system, procoagulant activity of the residual thrombus, presence of high shear forces that promote platelet deposition, and attenuation of physiologic fibrinolytic activity after pharmacologic thrombolysis. Preliminary data suggest that recently developed novel anticoagulants and antiplatelet agents may improve the rate of initial recanalization and prevent recurrent thrombus.
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The proportion of patients with acute myocardial infarction who are currently being treated with thrombolytic therapy is small. It is not readily apparent why the use of thrombolytic therapy is not more widespread. ⋯ Recent data suggests that the benefits of thrombolytic therapy should be extended to these selected high-risk subgroups. A philosophy of finding a reason not to treat with thrombolytic therapy should be adopted by all practicing clinical cardiologists.
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A primary failure rate to achieve reperfusion by thrombolytic therapy in acute myocardial infarction of 20-40%, an early reocclusion rate of 5-20%, as well as an increased risk of bleeding that excludes many patients from this form of therapy are today considered main problems. Better application of conventional thrombolytic agents, new conjunctive therapies and development of improved plasminogen activators are investigated with the aim of minimizing these problems.