Current aspects of thrombolytic therapy in unstable angina pectoris

In the last years, several studies addressed the role of the different antithrombotic therapeutics in unstable angina pectoris. Acetylsalicylic acid still is the standard treatment reducing the rate of death and myocardial infarction by 50% in the first six months. Ticlopidin has no clinical effect in the first six days and therefore is not suited for treatment in the acute phase. Unfractionated heparin has an additional favourable effect when added to aspirin. Low molecular weight-heparin is at least as effective as UF-heparin. Direct thrombin-inhibitors (hirudin, hirudin-analoga) seem to be comparable to UF-heparin. Plasminogen-activators should not be given in unstable angina, as they show a tendency to worsen the clinical outcome. GP IIb/IIIa-antagonists (antibodies, synthetic antagonists) significantly improve the clinical effects of aspirin. When combined with a reduced dose of heparin, their favourable effect remains unchanged, while bleeding complications are reduced to a minimum.