In Patients With ST-Segment Elevation Myocardial Infarction, Which Fibrinolytic Agent Is the Safest and Most Effective?

Forty studies met inclusion criteria, involving 128,071 STEMI patients treated with 12 fibrinolytic regimens. Four fibrinolytic agents (streptokinase, reteplase, tenecteplase, and alteplase at 2 separate dosing regimens) were compared as reperfusion therapy alone or in combination with antithrombotic agents, including parenteral anticoagulants (ie, low-molecular-weight heparin, heparin, anti-Xa inhibitor, and direct thrombin inhibitor) or glycoprotein IIb or IIIa inhibitors (ie, abciximab, tirofiban, or eptifibatide) (Table).

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