Thrombolytic and anticoagulant therapy in acute coronary syndrome

Reperfusion has an undoubtful clinical importance in acute coronary syndrome (ACs). Through the results of the TIMI II B study, Enoxaparin, i.e. low molecule weight heparin has been proved capable of reducing death incidence caused by acute stroke, myocardial infarction and reinfarction, as well as of reducing the need for revascularization and occurrence of heart failure or brain accidents. The aim of our study was to show the success rate and appropriacy of thrombolytic therapy and low molecule weight heparin Enoxaparin (Clexane) in acute myocardial infarction. A case report methodology and results: J. P., aged 37, farmer, was admitted to the coronary unit of Pancevo hospital due to protracted retrosternal pains persisting for the two previous hours. The pains were accompanied with general weakness and excessive perspiration. The patient had first felt heart disorders in the form of fatigue and lack of air while he was doing his national service. He reported having painful sensations in his chest lasting for several minutes and repeating occasionally throughout the past year. Eight years ago, the patient had pulmonary embolia following an underknee fracture. The patient is a smoker, obese with hyperlipoproteinimia and latent diabetes. ECG: Sinus rhythm phr. 80 per min., ST elevations in D2, D3, a VF with QR in the same leads, high T septal and apical. CK 696 and CK-Mb 44U/L, INR 1.23. Rtg with echocardiography, 24-hour Holter-ECG. With vectorcardiography we diagnosed heart decompensation, low 20%- EF left ventricule, rhythm disorder, infarct of the diaphragm wall and intrainfarct block septally. The patient was treated according to the protocol, with 1.5 mil. IU streptocinase and 30 mg Enoxaparin (Clexane), with 100 mg Aspirin. During the next 10 days, Enoxaparin was administered in 100 mg doses two times a day, with ACI inhibitors, B-blockers and coronary dilatators. Since no significant stenotic changes were found on coronary arteries, medication therapy was recommended. Post-therapeutic ECHO showed a significant EF increase by 45%, whereas the ECG disclosed only a minor scar on diaphragm and discrete apical ischaemia. Conclusion: ST -resolution is a consequence of better reperfusion, within recannulation achieved by Streptocinase and Enoxaparin. Likewise, the signs of cardial decompensation were withdrawn while EF was significantly increased. There was no need for myocardial revascularization.