From the Guidelines
Newer Thrombolytic Agents for STEMI
The most effective thrombolytic agents for ST-Elevation Myocardial Infarction (STEMI) are primary percutaneous coronary intervention (PCI) and fibrinolysis, with primary PCI being the preferred reperfusion strategy 1.
- Primary PCI involves the use of potent dual antiplatelet therapy, which has been shown to improve clinical outcomes and reduce rates of acute stent thrombosis 1.
- Fibrinolysis is an alternative option, particularly in low- and middle-income countries where access to primary PCI facilities is limited 1.
- Anticoagulation strategies for primary PCI include the use of heparin, enoxaparin, fondaparinux, and bivalirudin, with the choice of anticoagulant depending on various factors, including the patient's risk of bleeding and the availability of resources 1.
- Glycoprotein inhibitors (GPI) are also used in primary PCI to prevent thrombotic complications, with 79% of primary PCI patients in the United States receiving GPI agents in the first 24 hours of their hospitalization 1.
- A pharmaco-invasive strategy, which combines fibrinolysis with primary PCI, is a viable option for patients in low- and middle-income countries where access to primary PCI facilities is limited 1.
From the Research
Newer Thrombolytic Agents for STEMI
- The use of thrombolytic therapy in the treatment of ST-Elevation Myocardial Infarction (STEMI) has been widespread due to its safety, efficacy, ease of use, and affordability 2.
- However, primary percutaneous intervention is currently the preferred form of reperfusion therapy in the management of STEMI 2, 3.
- Thrombolytic therapy continues to have a role in many situations, especially in non-percutaneous coronary intervention (PCI)-capable hospitals 4.
- Newer thrombolytic agents, such as intracoronary thrombolysis, have been studied as adjunctive therapy to primary PCI in STEMI, showing potential benefits in improving microvascular perfusion and reducing thrombotic burden 5.
- The safety and efficacy of these newer agents are being explored in ongoing research, with some studies suggesting a strong trend towards fewer in-hospital major adverse cardiac events and improved complete ST-segment resolution 5.
Adjunctive Therapies
- Dual antiplatelet therapy, including aspirin and clopidogrel, as well as newer agents like prasugrel and ticagrelor, has become a mainstay of treatment for STEMI 3.
- Antithrombotic therapy, such as bivalirudin, has also been shown to improve outcomes in STEMI care 3.
- The use of coronary stents, including drug-eluting stents (DES) and bare metal stents (BMS), is being studied in primary PCI for STEMI, with ongoing research examining the trade-off between lower rates of in-stent restenosis and the potential increase in the risk of stent thrombosis 3.