[Aspirin and heparin in the fibrinolytic treatment of acute myocardial infarction]

Abstract

There is now extensive evidence of activation of platelet and the coagulation cascade with coronary thrombosis, and further activation with exogenous thrombolysis. Administration of aspirin and heparin has been shown to improve mortality when combined with thrombolytic therapy in acute myocardial infarction, probably by enhancing lysis and reducing subsequent reocclusion of infarct related artery. Most studies have evaluated the effect of aspirin or heparin in combination with streptokinase. These results can probably be extrapolated to rtPA, as it has much shorter, half live, and induces lower systemic lytic state. Although aspirin and heparin have been tested independently, they probably have a synergistic action post fibrinolysis. With current information it is mandatory to include aspirin in the treatment of AMI, with or with out thrombolytic treatment. Intravenous administration of heparin seems justified, specially if rtPA is used as fibrinolytic agent. Potent new drugs capable of inhibiting platelets an the coagulation cascade emerge as a promising future. Until their effect is clinically proven, aspirin and i.v. heparin should remain as adjunctive therapy to fibrinolytic treatment in AMI.