Verstraete M
Acta Cardiol. 1991;46(5):517-26.
Despite enormous advances made in understanding of the biochemistry of fibrinolytic agents and their extensive clinical use in acute myocardial infarction a number of unresolved issues remain. There is an intriguing divergence of left ventricular response and reduction of mortality in patients with acute myocardial infarction treated with thrombolytic drugs. It is also difficult to explain why patients treated late have a reduced mortality after thrombolytic treatment. Uncertainty prevails on the validity of thrombolysis in patients with a low and very high risk of mortality. Resistance of coronary occlusion to any thrombolytic is another unexplained fact. Alteplase and saruplase are more fibrin-specific thrombolytic drugs than anistreplase. These and the thrombolytic drugs of the first generation (streptokinase and urokinase) have shortcomings and limitations. It is being explored whether prolonged intravenous maintenance infusions are more effective if replaced by a bolus injection, accelerated infusion or the combined intravenous administration of thrombolytic agents.
尽管在纤溶药物生物化学的理解以及其在急性心肌梗死中的广泛临床应用方面取得了巨大进展，但仍存在一些未解决的问题。在用溶栓药物治疗的急性心肌梗死患者中，左心室反应和死亡率降低存在有趣的差异。同样难以解释的是，为何延迟治疗的患者在溶栓治疗后死亡率会降低。对于死亡率低和非常高风险的患者，溶栓的有效性仍存在不确定性。冠状动脉闭塞对任何溶栓药物的抵抗是另一个无法解释的事实。阿替普酶和沙芦普酶比茴酰化纤溶酶原链激酶激活剂更具纤维蛋白特异性。这些药物以及第一代溶栓药物（链激酶和尿激酶）都有缺点和局限性。正在探索延长静脉维持输注是否被大剂量注射、加速输注或溶栓药物联合静脉给药替代会更有效。
