Combining glycoprotein blockers with fibrinolysis: a bold stroke?

See doi:10.1016/j.ehj.2003.07.004for the article to which this editorial refers For the future treatment of ST-elevation myocardial infarction, fibrinolytic therapy will be the most widely used therapy, because of its simplicity, worldwide availability and relatively low cost. In comparison to primary angioplasty, which will continuously be hampered by its limited availability and inherent time delay, fibrinolytic therapy has two major drawbacks: partial efficacy and a small, but significant risk of major life-threatening bleeding. Several modifications in fibrinolytic drug design have optimized simplicity and efficacy in that 90min patency of about 60% can be achieved withthe bolus agents tenecteplase and reteplase. Butlife-threatening bleeding, especially intracranial bleeding, remains a serious problem. Fig. 1 Meta-analysis of the incidence of severe extracranial bleeding in the published acute ST elevation infarction trials comparing full dose fibrinolysis to reduced dose fibrinolysis combined with glycoprotein IIb/IIIa receptor antagonists (test for …