부산대학교 도서관

Fibrinolytic therapy is still necessary to treat ST-elevation myocardial infarction patients in many centres worldwide because of limited access to catheterization facilities. In contemporary practice, fibrinolysis is given as a bolus combined with anticoagulation and antiplatelets, followed by an early catheterization in a strategy termed the ‘pharmacoinvasive approach’. In this strategy, ST-segment resolution is checked at 60–90 minutes after fibrinolysis. Patients without signs of reperfusion are immediately taken to the catheterization laboratory, while stable, successfully reperfused patients receive a ‘scheduled’ catheterization between 2 and 24 hours after thrombolysis. The advantage of this approach is that unnecessary percutaneous coronary intervention procedures can be avoided in the very early phase after lysis when the risk of prothrombotic and bleeding complications is higher. The optimal dose of bolus fibrinolysis in pharmacoinvasive strategies remains unclear and is currently being prospectively studied.