Rev Esp Cardiol
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Review Comparative Study
[Comparison of clinical efficacy of thrombolytic drugs in patients with acute myocardial infarction].
Thrombolytic 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. ⋯ 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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Review Comparative Study
[Aspirin and heparin in the fibrinolytic treatment of acute myocardial infarction].
There is now extensive evidence of activation of platelet and the coagulation cascade with coronary thrombosis, and further activation with exogenous thrombolysis. Administration of aspirin and heparin has been shown to improve mortality when combined with thrombolytic therapy in acute myocardial infarction, probably by enhancing lysis and reducing subsequent reocclusion of infarct related artery. Most studies have evaluated the effect of aspirin or heparin in combination with streptokinase. ⋯ Intravenous administration of heparin seems justified, specially if rtPA is used as fibrinolytic agent. Potent new drugs capable of inhibiting platelets an the coagulation cascade emerge as a promising future. Until their effect is clinically proven, aspirin and i.v. heparin should remain as adjunctive therapy to fibrinolytic treatment in AMI.