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.