Because coronary thrombosis plays a role in unstable angina, one would expect lytic agents to be useful in unstable angina. Although this makes sense intuitively, it has yet to be shown. On angiography, the coronary artery appears to improve with the thrombolytic agent, but such therapy does not seem to alter the clinical outcome and may just expose the patient to the risk of bleeding.
Compare the benefit of immediate angioplasty versus intravenous thrombolytic therapy.
Contraindications may prevent the use of intravenous thrombolytic therapy in 60-70% of patients presenting with acute myocardial infarction. Clearly, in this group, direct angioplasty presents a therapeutic option.
Recently, a study compared direct angioplasty to tPA (although not in accelerated dosing forms), and noted that percutaneous coronary angioplasty (without prior use of thrombolytic therapy) reduced the combined occurrence of reinfarction, death, and intracranial bleeding.