The Role of Thrombolytic Drugs in the Management of Acute Myocardial Infarction and Stroke.

nagement of patients with thrombotic and thromboembolic complications during pre-, peri-, and postinterventional cardiologic procedures and acute thrombotic stroke, most often in combination with anticoagulants, antiplatelet agents or mechanical procedures, in order to achieve vascular reperfusion. Coronary Heart disease (CHD) is the most common cause of mortality not only in the United States (accounting for 481.287 deaths in 1995) but world-wide[1,2]. Annually an estimated 1.1 million Americans experience a new or recurrent acute myocardial infarction (AMI) due to CHD and in one -third of individuals the event is fatal[1]. The age-adjusted mortality rate of CHD has declined dramatically from 2.8% per year in 1965 to 1.5% since 1990[3]. The reasons for the age-adjusted decline in incidence, case-fatality, and CHD mortality rate are many: The advent of coronary care units with intensive monitoring, aggressive treatment of complications, and reperfusion therapies such as thrombolysis, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft (CABG) surgery[4-6]. The goal in the care of patients with AMI is to make these effective treatments available in a timely manner. With the advances in antithrombotic and anticoagulant drugs have come significant developments in the field of thrombolytic therapy. It is now possible to produce recombinant forms of tissue-type plasminogen activator (tPA), urokinase, prourokinase, and staphylokinase etc. by the use of recombinant DNA technology. Recombinant urokinase and prourokinase are expressed from mouse hybridoma cell line, and the latter, a precursor of urokinase, has such advantages as increased potency and increased effectiveness of thrombolytic therapy. The development of longer acting tPAs, fibrin-specific agents, and newer urokinase-type plasminogen activators may be beneficial in new indications of thrombolytic therapy such as thrombotic stroke.