Coronary patency after thrombolysis.

The immediate direct aim of thrombolytic therapy is rapid recanalization of the infarct-related coronary artery. Coronary patency rates observed in the different placebo-controlled and direct comparative trials of thrombolytic agents at different times after the onset of treatment are summarized. It is concluded that 1) for early reperfusion rt-PA is more effective than the other agents, 2) but that at the time of hospital discharge the observed patency rates are very similar for the different fibrinolytic agents and, surprisingly, not different from those obtained with antithrombotic treatment alone (= combined effect of endogenous thrombolysis and antithrombotic treatment!). New approaches to improve early reperfusion rates are discussed.