caa a22 4500 477062172 CHVBK 20180405111403.0 cr unu---uuuuu 170330e19960601xx s 000 0 eng 10.1007/BF00132405 doi (NATIONALLICENCE)springer-10.1007/BF00132405 Topol Eric Joseph J. Jacobs Center for Thrombosis and Vascular Biology and the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA aut Potential for a new coronary thrombolytic plateau [Elektronische Daten] [Eric Topol] The GUSTO-I trial provided definitive evidence that early and complete thrombolysis are closely associated with clinical outcome. However, in this trial the best thrombolytic strategy, consisting of accelerated t-PA, aspirin, and heparin, only yielded restoration of brisk flow (TIMI 3) in 54% of patients at 90 minutes after therapy. There are a variety of new strategies aimed at improving the rate of early TIMI flow, consisting of new plasminogen activators, anticoagulants, and platelet inhibitors. The third generation plasminogen activators include reteplase (r-PA), n-PA, bat-PA, staphylokinase, and TNK. To date, none of these molecules have been clearly associated with superior rates of infarct vessel patency, but comparative trials are in progress. Potent inhibitors of thrombin are recombinant hirudin, the most potent naturally occurring anticoagulant known, and synthetic direct thrombin inhibitors such as hirulog and argatroban. In the years ahead, agents that block the generation of thrombin, a step higher up in the coagulation cascade, such as factor Xa inhibitors, will be clinically pursued. The platelet glycoprotein IIb/IIIa inhibitors are a potent class of agents directed against the final common pathway for platelet aggregation, and pilot studies suggest excellent potential for facilitating early thrombolysis. Accordingly, a multitiered strategy of improved plasminogen activators, thrombin inhibitors, and antiplatelets is likely to result in far better clinical outcomes for myocardial reperfusion therapy in the future. Kluwer Academic Publishers, 1996 coronary thrombolysis nationallicence thrombosis nationallicence fibrinolytics nationallicence platelets nationallicence thrombin nationallicence Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/2(1996-06-01), 127-134 0929-5305 3:2<127 1996 3 11239 https://doi.org/10.1007/BF00132405 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00132405 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Topol Eric Joseph J. Jacobs Center for Thrombosis and Vascular Biology and the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/2(1996-06-01), 127-134 0929-5305 3:2<127 1996 3 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer