Thrombolytic therapy in acute myocardial infarction. A perspective.

This paper deals with the history of thrombolytic therapy from its inception to its application in acute myocardial infarction. It describes the discovery of streptococcal fibrinolysin, followed by the elucidation of the plasma proteolytic enzyme system concerned with fibrinolysis. An outline is given of the therapeutic basis for the decision to concentrate on the development of activators of the enzyme, rather than the enzyme itself. Early attempts to demonstrate the value of streptokinase and urokinase in the treatment of myocardial infarction are examined. Finally, the more encouraging approaches in current use, especially the early application of thrombolytic therapy after the onset of the morbid event, are discussed.