Circulation, Vol 73, 347-352, Copyright © 1986 by American Heart Association
HK Gold, RC Leinbach, HD Garabedian, T Yasuda, JA Johns, EB Grossbard, I Palacios and D Collen
Twenty-nine patients with acute myocardial infarction were treated with
recombinant human tissue-type plasminogen activator (rt-PA). The incidence
of acute coronary reocclusion and its prevention by a maintenance infusion
of rt-PA were studied. Intravenous rt-PA was given at a rate of 0.4 to 0.75
mg/kg over 60 to 120 min after angiographic documentation of complete
coronary occlusion. Reperfusion was accomplished within 1 hr in 24 of 29
patients (83%) and was associated with a decrease of the plasma fibrinogen
level by 20%. In a first group of 13 patients, 11 of whom were successfully
reperfused, prevention of reocclusion was attempted with heparin
anticoagulation. However, acute reocclusion within 1 hr after cessation of
rt-PA was demonstrated angiographically in five of these patients (45%).
Quantitative angiographic analysis indicated that acute reocclusion only
occurred in patients with 80% or greater residual stenosis. In patients
with less than 80% residual stenosis, heparin anticoagulation was
sufficient to maintain patency during the hospital stay in four of five
patients. In a second group of patients (n = 16), 13 of whom underwent
reperfusion with intravenous rt-PA, seven demonstrated a residual stenosis
of 80% or greater. These patients were given heparin and, in addition, 10
mg of rt-PA per hour for 4 hr. None developed acute angiographic
reocclusion or clinical signs of reocclusion during the hospital stay.
Repeat angiography at 10 to 14 days confirmed persistent patency in six of
the seven patients. The maintenance infusion resulted in only a moderate
additional drop in fibrinogen, while a steady-state plasma rt- PA level of
750 +/- 250 ng/ml was maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Acute coronary reocclusion after thrombolysis with recombinant human tissue-type plasminogen activator: prevention by a maintenance infusion
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