Coronary artery thrombolysis: comparison of approved agents.
Three agents approved for the lysis of thrombi in coronary arteries--alteplase, anistreplase and streptokinase--have undergone critical clinical experimental trials in Europe and the United States. Global comparison of their efficacy shows that alteplase is slightly more effective (71 percent) in restoring patency than anistreplase (60 percent) and streptokinase (58 percent). Streptokinase and anistreplase are allergenic, and repeat administration is not feasible in the short-term, a distinct advantage for alteplase. More accurate dosing of thrombolytic agents and skillful use of aspirin and heparin improve the efficacy of thrombolytic therapy but can also increase the risk of bleeding. A recanalization rate of 90 percent or more could be achieved if the thrombolytic agent is administered within the first hour after thrombosis. Administration this soon after the development of thrombosis may be possible if the agent is given outside the hospital by practicing physicians or, perhaps, paramedics.
Porter
R S
RS
Hahnemann University School of Medicine, Philadelphia, Pennsylvania.
DiPalma
J R
JR
D016255:Anistreplase / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D013300:Streptokinase / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D016255:Anistreplase; D013300:Streptokinase; D010959:Tissue Plasminogen Activator