New approaches to the management of AMI: Fibrinolysis plus GP IIb/IIIa receptor blockade

Current thrombolytic regimens improve survival of patients with acute myocardial infarction but have shortcomings, including inadequate rates of complete reperfusion, reocclusion after clot lysis, and bleeding complications. Genetically engineered mutants of tissue-plasminogen activator (t-PA) can be administered by bolus rather than infusion. These newer agents have not shown definitive clinical improvements over t-PA, but they have practical and economic advantages and the potential to reduce medication errors. Platelet glycoprotein (GP) IIb/IIIa receptor inhibitors, a class of potent antiplatelet agents, are successful in treating patients with acute coronary syndromes both within and outside the catheterization laboratory. The combination of thrombolytic agents with GP IIb/IIIa inhibitors has produced encouraging results in pilot phase-II dose-ranging and angiographic trials. Combination therapy has produced higher Thrombolysis in Myocardial Infarction (TIMI) 3 flow rates than either therapy alone. Optimal benefits, including meaningful reductions in bleeding complications, depend on further refinements to the doses of both thrombolytics and the adjunctive heparin regimens used in combination therapy.