Sousa et al Use of glicoprotein IIb/IIIa inhibitor and streptokinase

A 38-year-old man with acute myocardial infarction in the lower wall affecting the right ventricle underwent thrombolytic treatment with streptokinase. Approximate-ly 2 hours after the thrombolytic treatment started, he pre-sented with signs of coronary reocclusion. He underwent emergency cineangiocoronariography that revealed that his right coronary artery was completely occluded by a clot. He unsuccessfully underwent angioplasty and stent implantation. After the concomitant use of glycoprotein IIb/IIIa inhibitor, coronary TIMI III flow was achieved wi-thout additional dilations, and he was discharged from the hospital 5 days later with no further complications. Antiplatelet therapy for acute coronary syndrome is widely established 1. As for acute myocardial infarction, the data from the ISIS 2 study showed clearly that acetylsalicylic acid, alone and/or combined with thrombolytic therapy with streptokinase, plays a role in the reduction of mortality 2. Over the last few years, important progress has been made in this field as new and stronger antiplatelet drugs, such as the gly-coprotein IIb/IIIa inhibitors, have been discovered. Howe-ver, the role of these new medications as a primary support therapy in acute myocardial infarction still needs to be better understood. Case Report A 38-year-old male patient, smoker, previously in good health, came to the emergency department complaining of a 4-hour-long oppressive retrosternal pain that had started du-ring intense exercise, irradiating to the left upper limb, accom-panied by dyspnea, sweating and vomiting, which improved slightly after sublingual nitrate and aspirin administration