Immediate Pharmacology in the Current Era of Reperfusion Therapy

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However, such practice seems reasonable, given the limited disadvantages of such an approach in terms of bleeding, and the infrequent requirement for urgent coronary artery bypass grafting (CABG) in the context of reperfusion therapy. No definitive advantages with the novel antithrombin approaches in primary PCI have yet been clarified. Such benefits should not be inferred from the trials with fibrinolysis, due to the greater impact of these agents on recurrent MI and the lower rates of this event following primary PCI compared with fibrinolysis. Whether the early initiation of these antithrombin therapies will extend the window of benefit and therefore allow improved access to primary PCI needs further exploration. Nevertheless, the over-arching consideration is the effective incorporation of these agents, whichever choices are made, into effective and timely systems of care in order to realize the clinical benefits promised by the randomized trial data. Ôûá

Acknowledgement

The authors would like to thank Barbara Semb for expert secretarial assistance.

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