| Title | Ultra rapid infusion of rt-PA in acute myocardial infarction | |
| Authors | I. Kanonidis¹, C. Papadopoulos¹, G. Koukoulekidis¹, L. Papayannis¹, N. Nikolaidis¹, B. Pavlidis¹, G. Sakadamis¹, B. Kokkas² and C.Th. Gitsios¹
1. 2nd Cardiology Department and 2. Laboratory of Pharmacology, Aristotle University of Thessaloniki, Greece |
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| Citation | Kanonidis, I.E., Papadopoulos, C.L., Koukoulekidis, G., Papayannis, L., Nikolaidis, N. et al.: Ultra rapid infusion of rt-PA in acute myocardial infarction, Epitheorese Klin. Farmakol. Farmakokinet. 12(3): 39-46 (1998) | |
| Publication Date | Received for publication: 15 October 1997
Accepted for publication. 20 October 1997 |
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| Full Text Language | English | |
| Order – Buy | pharmakonpress[at]pharmakonpress[.]gr | |
| Keywords | Thrombolysis, myocardial infarction, recombinant tissue-type plasminogen activator, front loaded regimens. | |
| Other Terms | Statistical study | |
| Summary | Clinical evidence supports the point that the earlier the reperfusion the better the prognosis. In that view we studied an ultra-rapid infusion scheme of rt-PA in 73 patients presented within 4 hours from onset of symptoms for Acute Myocardial Infarction (AMI). Included patients had no previous history of AMI, hypertension or any other cardiovascular disease. Thirty-five of these patients were given rt-PA 50 mg IV bolus followed by 50 mg iv infusion in 30 min. The remaining 38 were assigned to the standard regimen that is 100 mg rt-PA given as 10 mg IV bolus followed by IV infusion of 90 mg in 90 min. Heparin was given concomitantly. Reperfusion was evaluated 1 hour after treatment by noninvasive criteria that are: a) relief of pain, b) resolution of ST segment elevation. The latter was evaluated quantitatively (ST index) as the percentage of reduction of the sum of ST elevations in all affected leads from basal (pre-treatment) values. If ST index was <50% reperfusion was considered to have taken place. Coronary angiography carried out at discharge (7-10 days) and 30 day mortality was also evaluated. The rapid infusion did not cause any changes in blood pressure or cardiac rhythm. Signs of reperfusion were noticed in 32 patients in the ultra-rapid group (91%) and in 27 patients (71%) in the standard group. ST reduction correlated well with time from onset of symptoms to onset of treatment in the ultra-rapid infusion group. Four cases of reocclusion were noticed. Mortality was excellent in both groups. Coronary angiography did not reveal any differences in coronary artery patency between the two groups. Ultra rapid infusion of rt-PA is a safe and very effective means of promptly restoring a long lasting coronary patency in the setting of AMI. | |
| References | 1. Clemmensen P., Ohman E.M., Sevilla D.C. et al.: Changes in standard electrocardiographic ST-segment elevation predictive of successful reperfusion in acute myocardial infarction. Am. J. Cardiol. 66: 1407-1411 (1990)
2. Agnelli G., Buchanan M.R., Rernandez F., Hirsh J.: The thrombolytic and haemorrhagic effects of tissue type plasminogen activator: influence of dosage regimens in rabbits. Thromb. Res. 4a: 769-775 (1985) 3. Clozel J.-P., Tschopp T., Luedin E., Hoivoet P.: Time course of thrombolysis induced by intravenous bolus or infusion of tissue plasminogen activator in a rabbit jugular vein thrombosis model. Circulation 79: 125-133 (1989) 4. Carney R.J., Murphy G.A., Brandt T.R., et al.: Randomized angiographic trial of recombinant tissue-type plasminogen activator (alteplase) in myocardial infarction. J. Am. Coll. Cardiol. 20: 17-23 (1992) 5. Neuhaus K.-.L, Fauerer W., Jeep-Tebbe S., et al.: Improved thrombolysis with a modified dose regimen of recombinant tissue-type plasminogen activator. J. Am. Coll. Cardiol. 14: 1566-1569 (1989) 6. Tebbe U., Tanswell, P., Seifried E.P et al.: Single-bolus injection of recombinant tissue-type plasminogen activator in acute myocardial infarction. Am. J. Cardiol. 64: 448-453 (1989) 7. Tranchesi B., Versiracte M., Vanhove P., et al.: Intravenous bolus administration of recombinant tissue plasminogen activator to patients with acute myocardial infarction. Cor. Art. Dis. 1: 83-88 (1990) 8. Levine M., Hirsh J., Weitz J., et al.: A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator to patients with acute pulmonary embolism. Chest 98: 1473-1479 (1990) 9. Hackett D., Andreotti F., Haider A.W., et al.: Effectiveness and safety of a single intravenous bolus injection of tissue-type plasminogen activator in acute myocardial infarction. Am. J. Cardiol. 69: 1393-1398 (1992) 10. Kawai C., Hosoda S., Motomiya T., et al.: Multicenter trial of a novel modified t-PA, E6010 by i.v. bolus injection in patients with acute myocardial infarction (AMI) (abstract). Circulation 86 Suppl 1: 1-409 (1992) 11. Von Essen R., Neuhaus K.-L., Markreiter M., et al.: Double bolus of t-PA in the dosage finding. Results of the GRECO II-study (abstract). J. Am. Coll. Cardiol. 19: 274A (1992) 12. Purvis J.A., Trouton T.G., Roberts M.J.D., et al.: Effectiveness of double bolus alteplase in the treatment of acute myocardial infarction. Am. J. Cardiol. 68: 1570-1574 (1991) 13. Gemmill J.D., Hogg K.J., MacIntyre P.D., et al.: A pilot study of the efficacy and safety of bolus administration of alteplase in acute myocardial infarction. Br. Heart J. 66: 134- 138 (1991) 14. Purvis J.A., Booth N.A., Wilson C.M., et al.: Anaphylactoid reaction after injection of alteplase (letter). Lancet 341: 966-967 (1993) 15. Massel D., Gill J.B., Cairns J.A.: Anaphylactoid reaction during an infusion of recombinant tissue-type plasminogen activator for acute myocardial infarction. Can. J. Cardiol. 7: 298-302 (1991) |
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