Circulation, Vol 79, 281-286, Copyright © 1989 by American Heart Association
EJ Topol, BS George, DJ Kereiakes, DC Stump, RJ Candela, CW Abbottsmith, L Aronson, A Pickel, JM Boswick and KL Lee
To evaluate the coronary thrombolytic efficacy of tissue plasminogen
activator (t-PA) and early intravenous heparin, 134 patients with acute
myocardial infarction were randomly assigned to combination therapy or t-PA
only. At a median of 2.78 hours from symptom onset, 64 patients received
both t-PA (1.5 mg/kg/4 hr) and a bolus of 10,000 units heparin, whereas 70
patients received t-PA alone at the same dose. All patients underwent
coronary angiography 90 minutes after initiation of therapy to determine
infarct vessel patency status, after which time the control group patients
were eligible to receive heparin. Baseline demographic and angiographic
characteristics were similar for the groups. Infarct vessel patency was 50
of 63 (79%) for combination t-PA and heparin and 54 of 68 (79%) for t-PA
alone. Bleeding complications, as reflected by need for transfusion, were
similar in the two groups: 13% in the patients treated with t-PA and
heparin compared with 18% in patients treated with t-PA only (p = 0.53).
The only intracranial hemorrhage in the trial occurred in a patient
initially treated without heparin. Fibrinogen at 50 minutes after therapy
was 32% decreased from baseline for the t-PA and heparin-treated patients
compared with a 39% decrease in the control group. Predischarge left
ventricular ejection fraction was similar for the two groups: 49.0 +/-
10.1% versus 50.2 +/- 11.9% for combined versus t-PA only therapy,
respectively. We conclude that early intravenous heparin does not
facilitate the fibrinolytic effect of t-PA at the doses tested.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
A randomized controlled trial of intravenous tissue plasminogen activator and early intravenous heparin in acute myocardial infarction
Department of Internal Medicine, University of Michigan, Ann Arbor.
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