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