Fibrinolysis

STK

GISSI 1

ISIS 2

STK is better than aspirin alone. STK + aspirin is even better. GISSI shows that STK should be given as early as possible.

Which one is better?

Alteplase

GUSTO 1 - results in better reflow than STK

Reteplase

GUSTO III - non inferior to STK.

INJECT - lower complications. (fewer shock, low HF)

Tenecteplase

TIMI10A and 10B - Similar efficacy to rTPA

TIMI 10A

TNK-TPA has a prolonged half-life so it can be administered as a single bolus. TNK-TPA appears to be very fibrin specific, and the initial patency and safety profiles are encouraging. Further study of this new thrombolytic agent is ongoing.