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Thrombolysis: adjuvant therapy and the role of complement.

A possible role for adjuvant therapy following thrombolysis exists in the context of reperfusion injury and post-ischaemic dysfunction, or so-called 'stunned myocardium'. The question that arises is whether the extent of myocardial stunning, or the ultimate extent of necrosis, can be reduced by preventing reperfusion injury and the impairment of reflow. Essential to any attempted intervention is an understanding of the mechanisms underlying myocardial damage following ischaemia and reperfusion. Certain mediators responsible for injury and repair have been identified, and their effects modified in experimental preparations; the role of complement, in particular, is central to these phenomena. Lysis of coronary artery thrombus is only the initiator of a sequence of events involving vascular endothelium and an intravascular response to tissue injury. The challenge is whether reperfusion injury may be modified and whether such intervention will favourably alter clinical outcome.