Current cardiology reports
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Thrombolytic therapy aims to achieve rapid and sustained infarct-related artery patency, although this results in a procoagulant state. Heparin has limitations as an antithrombin agent, which has led to clinical investigation of alternative agents. Direct thrombin inhibitors, as adjuncts to thrombolytic therapy, have been shown to increase 90 minute Thrombolysis in Myocardial Infarction (TIMI)-3 flow rates and reduce reinfarction, when compared with heparin. ⋯ When the direct thrombin inhibitor hirudin was administered at a mean of 34 and 50 minutes after thrombolytic therapy in large clinical trials, there was no reduction in mortality. In contrast, in several angiographic studies, direct thrombin inhibitors were administered prior to thrombolysis. The effect on mortality of the administration of hirulog prior to streptokinase is currently being examined.
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The thienopyridine class of antiplatelet drugs includes ticlopidine and clopidogrel, drugs that are used increasingly to prevent ischemic events in and out of the cardiac catheterization laboratory. Formerly, the only oral antiplatelet drug available for these purposes was aspirin, which has been studied randomized placebo-controlled trials in which 70,000 patients have been enrolled. ⋯ Both ticlopidine and clopidogrel have been compared with aspirin in randomized controlled trials and both are approximately 10% more effective than aspirin. Recently, ticlopidine and clopidogrel have been compared with one another; clopidogrel appears to be at least as efficacious as ticlopidine, but with few fewer side effects.
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More than 200,000 people have been enrolled into clinical trials examining different reperfusion strategies for patients with acute myocardial infarction. Each year approximately 1 million people in the United States experience acute myocardial infarction. ⋯ These agents are often divided into "fibrin-specific" and "non-fibrin-specific" drugs. New thrombolytic agents designed to address several of the shortcomings of existing thrombolytics are in various stages of clinical development.