Thrombolytic therapy. Agents, indications, and laboratory monitoring.

Abstract

The patient must be educated to seek medical attention promptly when this malady strikes, and the physician must likewise be taught to institute this therapy as soon as the patient is seen. Less than 6 years ago, it was strongly expressed that there was no rationale for attempting to restore blood flow in the coronary arteries in the setting of myocardial infarction. It was believed that once the diagnosis of myocardial infarction was made, it was too late to relieve myocardial fibers and avert myocyte necrosis. If this thinking and advice of "the damage has already occurred" and "it is too late" prevailed, it would not be known today that treatment of myocardial infarction with thrombolytic therapy within 6 hours of onset of symptoms significantly reduces mortality in comparison with optimal medical treatment (including heparin) without thrombolytic therapy. The concept of thrombolytic therapy is correct. Persistent investigative work in this area will result in better thrombolytic agents and greater dexterity in their use. The thrombolytic agents available today are good, and they can be used safely. To state that agents that have been established to be capable of thrombus resolution should not be used in the treatment of thrombosis is a true example of how not to proceed toward improvement. To be content to remain in the past will not permit entrance into the future.