Godfried S L, Gaziano J M, Hennekens C H
Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA 02215-1204, USA.
J Cardiovasc Risk. 1996 Oct;3(5):453-7. doi: 10.1177/174182679600300507.
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.
抗栓和溶栓治疗在急性心肌梗死的治疗中具有明确的净效益。阿司匹林抗栓治疗可显著降低血管性死亡率、再梗死率和卒中发生率，所有疑似急性心肌梗死患者均应使用。目前，尚无明确证据表明在阿司匹林抗栓方案中加用延迟皮下注射或即刻静脉注射肝素会带来净效益。直接凝血酶抑制剂作为抗栓药物，理论上优于肝素，但需要大规模随机试验提供更多数据，以确定这些药物与阿司匹林联用时是否能带来净效益。溶栓治疗可显著降低死亡率，所有症状发作12小时内的疑似急性心肌梗死患者均应考虑溶栓治疗。与任何一种可用溶栓药物更广泛使用和更早给药所带来的巨大益处相比，各种溶栓药物在疗效、安全性或给药便利性方面的差异较小。仅在美国，更广泛地使用抗栓和溶栓治疗急性心肌梗死每年就可预防数以万计的过早死亡，在全球范围内可预防数十万例。
