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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Ablation of reentrant ventricular tachycardia (VT) is an accepted therapy for certain patients with VT caused by coronary artery disease (CAD). Its use is currently limited to patients with sustained, monomorphic, hemodynamically tolerated VT. ⋯ Other recent studies have investigated attempted ablation of all inducible VTs in patients with multiple VT morphologies. In the future, substrate mapping may make possible ablation of VT in patients with nonsustained or fast, hemodynamically unstable VTs, thus allowing VT ablation to become a first-line therapy for many patients with VT in the setting of CAD.