Circulation, Vol 73, 338-346, Copyright © 1986 by American Heart Association
DO Williams, J Borer, E Braunwald, JH Chesebro, LS Cohen, J Dalen, HT Dodge, CK Francis, G Knatterud and P Ludbrook
The efficacy and safety of a 3 hr, 80 mg intravenous infusion of
recombinant tissue-type plasminogen activator (rt-PA) were investigated in
47 patients with acute myocardial infarction. Coronary angiography,
performed before the administration of rt-PA and for 90 min thereafter,
demonstrated that 37 patients had total coronary occlusion before therapy.
After 90 min of rt-PA (50 mg), reperfusion of the infarct- related artery
was observed in 25 patients (68%). Continuous infusions of heparin for
anticoagulation were administered for 8 to 10 days. Of 36 patients who
underwent follow-up coronary cineangiography, 21 had initially presented
with total occlusion and had experienced reperfusion at 90 min. Sustained
perfusion of the infarct-related artery was observed in 14 (67%) of these
21 initially reperfused patients. Late angiography was performed in nine
patients who initially demonstrated subtotal occlusion of the
infarct-related artery; sustained perfusion was observed in eight (89%).
Significant bleeding was observed in 15 patients (32%). A hematoma at the
site of the acute catheterization accounted for most instances of
significant bleeding (11/15, 73%). Administration of rt-PA resulted in a
significant decline in fibrinogen and plasminogen while amounts of
fibrin(ogen) degradation products rose. In no patient, however, did
fibrinogen levels decline to less than 140 mg/dl. Thus, rt-PA, administered
as a brief 80 mg intravenous infusion, is capable of restoring blood flow
in a high proportion of patients with acute myocardial infarction due to
total coronary obstruction. Declines in plasma fibrinogen and plasminogen
are observed. If combined with heparin anticoagulation and invasive
vascular procedures, significant bleeding is a common
complication.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Intravenous recombinant tissue-type plasminogen activator in patients with acute myocardial infarction: a report from the NHLBI thrombolysis in myocardial infarction trial
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