[Increased efficacy of thrombolytic therapy in acute myocardial infarction by improved properties of new thrombolytic agents]

Abstract

Thrombolysis is a milestone in the therapy of acute myocardial infarction due to its ubiquitous availability and ease of application. The recombinant form of tissue-type plasminogen activator (rt-PA) has been proven to be superior over first generation fibrinolytic agents (streptokinase, urokinase, APSAC) with respect to efficacy and side effects and the front-loaded regimen has meanwhile become the "gold"-standard of thrombolytic therapy. Biochemically modified mutants of wild-type t-PA, e.g. r-PA (reteplase), n-PA (lanoteplase), and TNK-t-PA have altered biochemical and pharmacokinetic characteristics which make them more easy to use (as double or single bolus injection) and share a theoretical efficacy benefit. This article describes these specific characteristics focussing on clot-selectivity and PAI-1 resistance of the new mutants of wild-type t-PA and their possible clinical efficiency.