Findings on the efficacy and safety of thrombolytic therapy. An analysis of key clinical trials.

This past decade has seen remarkable progress in the use of thrombolytic agents to increase survival after AMI. Early IC strategies and several reperfusion trials of thrombolytic therapy visually demonstrated the efficacy of these agents. The life-saving benefits of thrombolysis have been illustrated by the large multicenter mortality trials with decreases in mortality from 15% to 8%. Mortality rates in AMI treated with rt-PA has been shown to be much lower in studies using full-dose IV heparin: TIMI IIB 4.9% (6 weeks), ASSET 7.2% (1 month), ECSG 3.7% (21 days). SK and APSAC are most effective at achieving thrombolysis when administered early in the course of AMI; rt-PA retains its superior efficacy on the older thrombus. When patients are properly screened for contraindications, IV-thrombolytic therapy is a safe and highly effective treatment for AMI. The choice of agent remains that of personal or institutional preference. Only when definitive results of ongoing and future head-to-head clinical trials are published can the effectiveness of the agents be compared accurately. Until these data are available, the most important lesson is to treat and treat quickly.