ABSTRACT
Several randomized clinical trials (Gruppo Italiano per lo Studio della Streptochinase Nell’Infarto Miocardico (GISSI) (1), Wilcox et al. (2), and Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group (3) have shown that thrombolytic agents improve 30-day survival by approximately 30 percentage points following an acute myocardial infarction (AMI). Thrombolytic agents are plasminogen activators which convert plasminogen, a proenzyme, to plasmin, an enzyme capable of cleaving fibrin and producing clot lysis. Streptokinase, SK, is the oldest identified plasminogen activator and was the first commercially available thrombolytic agent. SK not only acts on clots but also on circulating fibrinogen, giving rise to systemic fibrinogenolysis. Tissue plasminogen activator (t-PA) is a direct plasminogen activator which is produced endogenously by endothelial cells. Commercial production is available by means of recombinant DNA technology, which makes it approximately eight times more expensive
than SK. This agent produces less systemic fibrinolysis than SK since it converts plasminogen to plasmin more efficiently in the presence of clot-bound fibrin.
