The most common reasons for delays in receiving fibrinolytic therapy were misdiagnosis of STEMI (including delays waiting for cardiac enzymes despite STEMI being obvious on the ECG or due to misinterpretation of the ECG), denial of fibrinolytic therapy on financial grounds in patients presenting to private hospitals, lack of familiarity with treatment protocols and inappropriate decision-making among attending doctors, especially inexperienced doctors, fear of complications, lack of urgency in administering the agents, absence of fibrinolytic agents
in the emergency room or hospital, and late patient presentation (after 12 hours).
Systemic therapy with fibrinolytic agents
continues to be controversial.
1% of patients (2 of 28) received fibrinolytic agents
before percutaneous coronary intervention; the remainder underwent primary percutaneous coronary intervention.
Local release of fibrinolytic agents
for adhesion prevention.
Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fibrinolytic agents
in suitable candidates and the timely transfer to PCI-capable facilities of patients that may still benefit from catheter reperfusion.
And they were less likely to receive early therapy with aspirin, fibrinolytic agents
, and [beta]-blockers, as recommended in national guidelines.
convert plasminogen to plasmin (fibrinolysin) that is able to break down fibrin.
Reteplase, tissue plasminogen activator (TPA), and other fibrinolytic agents
only partially dissolve clot, inducing downstream microvascular embolization of atheromatous material and clot.
are most effective when administered within 2 to 3 hours from symptom onset (12-15) with longer treatment delays leading to worse clinical outcomes (16).
The fibrinolytic agents
streptokinase and urokinase have also been used to treat acute thrombotic microangiopathy with varying success.
The first eight chapters describe the pharmacology and clinical utility of common antiplatelet, antithrombin, and fibrinolytic agents
, including aspirin, the thieneopyridines, glycoprotein IIb/IIIa inhibitors, unfractionated heparin, the low-molecular weight heparins, and direct thrombin inhibitors.