[Fibrinolytic agents in acute myocardial infarction. Reperfusion--a two-edged sword? Advantages and disadvantages of various preparations].

An account is presented of the problems which occur on reperfusion of the myocardium in connection with fibrinolytic treatment and the present day possibilities for reducing the complications. Restenosing is mentioned in particular. The advantages and disadvantages of the individual fibrinolytic preparations are illustrated. The clinical investigations available demonstrate that the higher frequencies of reperfusion for "fibrin selective" plasminogen activator are observed mainly in patients with durations of AMI symptoms for more than three hours before the commencement of thrombolytic treatment. In a comparison between t-PA and streptokinase investigations regardless of the time of inclusion no difference could be demonstrated in the effect on the left ventricular function, lethality after 12 months and the risk of haemorrhage. Employing APSAC and streptokinase, significant reduction in the one year lethality was found and, where streptokinase was concerned, on treatment up to 24 hours after the commencement of symptoms. Acetylsalicylic acid has an additive effect, possibly as a result of the reduced risk for rethrombosing among other things. The current data provide, however, no final explanation of the relative efficacy of the individual fibrinolytic drugs because the various investigations have had different forms of selection of patients, initiation of treatment and parallel medication. Attempts will be made to elucidate these in future investigations where ISIS-3 compares t-PA, streptokinase and APSAC while GISSI-2 will compare t-PA and streptokinase. Simultaneously, the value of heparin will be investigated in connection with fibrinolytic therapy.