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Thrombolytic therapy in patients with acute myocardial infarction

Keywords: myocardial infarction , thrombolysis , fibrinolytics , streptokinase , anistreplase , alteplase , reteplase , tenekteplase.

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It is reported that the implementation in clinical practice thrombolytic (fibrinolytic) therapy resulted in mortality reduction during first month after myocardial infarction from 17-18% to 5-8%. Different details of this therapy are considered: terms of thrombolysis since the beginning of myocardial infarction, alternative methods of coronary blood flow recovery, indications and contraindications, complications and side effects, estimation of thrombolysis efficacy. Fibrin-selective and fibrin-non-selective drugs are presented. Different fibrinolytics are described: streptokinase, anistreplase, alteplase, reteplase, tenekteplase. The results of large randomized clinical trials devoted to fibrinolytic therapy of myocardial infarction are analyzed: GISSI, ISSIS, TIMI, GUSTO, INJECT, ASSENT. The possibility to increase in efficacy and safety of fibrinolytics by their combination with acetylsalicylic acid, IIb/IIIa receptor inhibitors and heparins are discussed.


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