OBJECTIVE To discuss adjunctive pharmacologic agents for acute myocardial infarction, to critique their initial effects in clinical trials, and to review their potential for improving the clinical conditions of patients with acute myocardial infarction. DATA SOURCES Relevant studies reported from January 1985 to December 1990 were identified through a MEDLINE search of the English-language literature and through a manual search of the bibliographies of all identified articles. STUDY SELECTION Peer-reviewed experimental and clinical studies evaluating the role of pharmacologic adjuncts to thrombolytic therapy in experimental models of coronary occlusion and clinical trials of patients with acute myocardial infarction were selected for review. DATA EXTRACTION AND SYNTHESIS The data presented were abstracted by the investigators. Differences with a univariate P value of less than 0.05 were considered to be statistically significant. CONCLUSIONS Current clinical data suggest that adjunctive pharmacologic therapy to thrombolytic agents should include aspirin, at least 160 mg administered as soon as possible after the onset of symptoms; intravenous heparin; and, in selected patients without contraindications, intravenous beta-blockading agents.