[Thrombolytic therapy of acute myocardial infarct: which drugs? Which patients?].

The efficiency of thrombolytic therapy in acute myocardial infarction has been documented in a large number of studies. The reduction of mortality has been shown for streptokinase (SK) and APSAC and various combinations (SK and aspirin). The recanalisation-rate is higher for rtPA as is the reocclusion-rate. Major bleeding complications are similar for all agents. However, the incidence of intracranial bleedings seems to be higher with rtPA; thus the cost-effectiveness for the tissue plasminogen activators is questionable. Attempts are made to focus on the implications of the major clinical trials for the therapeutic strategy in different patient-groups.