Coronary Thrombosis in Perspective: Principles Underlying Conjunctive and Adjunctive Therapy (Fundamental and Clinical Cardiology)

This work clinically reviews advances in coronary thrombolysis and offers practical information for the optimal implementation of conjunctive and adjunctive measures needed when coronary thrombolysis is performed. It presents results of the GUSTO trial and discusses anticoagulants under development, including direct acting thrombins, inhibitors of coagulation factor X and tissue factor, and antiplatelet drugs. Illustrating methods and techniques that induce patency of thrombotically occluded coronary arteries, this introduces the concept of conjunctive therapy and differentiates it from adjunctive therapy; assesses the advantages and disadvantages of specific fibrinolytic agents for use in particular clinical circumstances; clarifies mechanisms underlying atherogenesis, coronary thrombosis and acute coronary syndromes; identifies the clinical considerations that must be addressed if coronary thrombosis is to be optimally effective; shows how fibrinolytic agents act as procoagulants; describes the relationship between the fibrinolytic system and the activation of platelets; and provides practical protocols for the use of clot-selective and nonclot-slective drugs to treat coronary thrombosis.