Antithrombotic and thrombolytic therapies for acute myocardial infarction.

Antithrombotic and thrombolytic therapies confer clear net benefits in the treatment of acute myocardial infarction. Antithrombotic therapy with aspirin yields conclusive reductions in vascular mortality as well as reinfarction and stroke, and should be administered to all patients with suspected acute myocardial infarction. There is presently no clear evidence of net benefits from adding either delayed subcutaneous or immediate intravenous heparin to an antithrombotic regimen of aspirin. Direct thrombin inhibitors have theoretical advantages over heparin as antithrombotic agents, but further data are needed from large-scale randomized trials to determine whether these agents confer net benefits when given in conjunction with aspirin. Thrombolytic therapy yields clear reductions in mortality and should be considered for all patients with suspected acute myocardial infarction presenting within 12 h of symptom onset. The differences in the efficacy, safety or ease of administration of the various thrombolytic agents are small compared with the substantial benefits that would result from the wider use and earlier administration of any of the available agents. More widespread use of antithrombotic and thrombolytic therapies for acute myocardial infarction could prevent tens of thousands of premature deaths annually in the USA alone, and hundreds of thousands worldwide.