Concurrent antiplatelet and fibrinolytic therapy.

In patients who have myocardial infarction with STsegment elevation, rupture of an atherosclerotic plaque leads to platelet adhesion, activation, and aggregation, with subsequent vessel occlusion due to thrombus formation. In these circumstances, the most effective pharmacologic reperfusion regimen is concurrent fibrinolytic therapy and platelet inhibition. The marked benefit of such a combination was first established in the Second International Study of Infarct Survival, in which 35-day mortality among patients with suspected myocardial infarction was 13.2 percent for those receiving neither streptokinase nor aspirin, approximately 10.5 percent for those given one or the other, and 8.0 percent for those receiving both agents. 1