Circulation, Vol 77, 1100-1107, Copyright © 1988 by American Heart Association
EJ Topol, RM Califf, BS George, DJ Kereiakes, D Rothbaum, RJ Candela, CW Abbotsmith, CA Pinkerton, DC Stump and D Collen
To determine whether tissue-type plasminogen activator (t-PA) and urokinase
(UK) act synergistically to achieve coronary thrombolysis, incremental
doses of both drugs were infused intravenously over 60 min. In 146
consecutive patients treated 3.0 +/- 1.0 hr from symptom onset, coronary
angiography was performed 90 min after the start of the infusion and at 7
days. The groups of patients treated by different dose regimen were as
follows: group I, 14 patients treated with t-PA 25 mg and UK 0.5 million U;
group II, 20 patients given t-PA 25 mg and UK 1.0 million U; group III, 24
patients given t-PA 1.0 mg/kg and UK 0.5 million U; group IV, 33 patients
treated with t-PA 1.0 mg/kg and UK 1.0 million U; and group V, 55 patients
given t-PA 1.0 mg/kg and UK 2.0 million U. In groups I and II, patency of
the infarct-related vessel at 90 min was only 36% and 42%, respectively.
With 1 mg/kg t-PA and increasing doses of UK (groups III to V), patency
ranged from 72% to 75% (overall 73%). Repeat catheterization at 7 days
demonstrated reocclusion in groups III to V in 10 of 110 (9%). The patency
and reocclusion rates in groups III to V were not significantly different
from those in our previous study of 386 patients treated with t-PA alone
(150 mg over 6 to 8 hr). In that study the patency rate of the
infarct-related vessel at 90 min was 75% (p = .66) and reocclusion occurred
in 15% (p = .11).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Coronary arterial thrombolysis with combined infusion of recombinant tissue-type plasminogen activator and urokinase in patients with acute myocardial infarction
Department of Internal Medicine, University of Michigan, Ann Arbor.
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