Fibrinolytic Therapy
Introduction
When primary PCI for patients with STEMI is not possible within a timely fashion, fibrinolysis is an important means of reperfusion.
Indications and Contraindications
Fibrinolytic Agents
When fibrinolytic therapy is indicated, a fibrin-specific agent (alteplase, reteplase, or tenecteplase) is recommended over a nonfibrin-specific agent (eg, streptokinase) because of greater reperfusion success and less systemic bleeding with fibrin-specific agents.
- Any fibrin-specific agent is acceptable as no drug has demonstrated superiority over the others with regard to the mortality benefit.
Factors affecting the choice include
- Risk of major bleeding
- Ease of administration
- Formulary restrictions
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