Fibrinolytic therapy alternatives

The clear alternative to fibrinolytic therapy in the reperfusion strategy of ST-segment elevation acute myocardial infarction is primary coronary angioplasty. This therapy has a clinical benefit over the optimal thrombolytic strategy front-loaded rt-PA or tenecteplase (13). The major drawback of primary angioplasty is its limited availability and treatment delay. The... 

Typically, patients with confirmed CVST are treated with intravenous heparin even in the presence of intracerebral hemorrhage. Although there is only one placebo-controlled, double-blind study showing a significant advantage of intravenous dose-adjusted unfractionated heparin therapy in patients with CVST (Einhaupl et al. 1991), heparin as the first-line treatment is recommended because of its efficacy, safety and feasibility (Ameri and Bousser 1992 Bousser 1999). Only in rare cases may fibrinolytic therapy or thrombectomy be considered as alternative treatment options. 

Despite the results of the PAMI and Zwolle trials, great controversy persisted regarding the relative benefit of catheter-based reperfusion versus fibrinolytic therapy for acute myocardial infarction. Primary PTCA was regarded as a reasonable alternative to fibrinol)dic therapy but was not widely employed due to logistical problems and relative paucity of data to support its clinical benefit. It took a further decade of clinical research to settle this controversy. 

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