Safety and efficacy of a new regimen of intravenous recombinant tissue-type plasminogen activator potentially suitable for either prehospital or in-hospital administration.
The safety and efficacy of a new regimen of intravenous recombinant tissue-type plasminogen activator (rt-PA) potentially suitable for either pre- or in-hospital administration were assessed in 60 patients with acute myocardial infarction in an open label coronary angiographic study. The regimen consisted of a 20-mg bolus dose followed 30 min later by a delayed infusion of 80 mg over 2 h. This regimen was designed to facilitate prehospital administration of rt-PA. Infarct-related artery patency (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3 flow) was observed in 40 of 53 patients at 60 min (75.5%, 95% confidence intervals [CI] 61% to 84%) and in 55 of 60 patients at 90 min (91.7%, 95% CI 80% to 95%) after the rt-PA bolus. By 90 min the majority of patients (55%) exhibited TIMI grade 3 flow; infarct artery patency at 120 min was 84.9%. During hospitalization definite recurrent ischemia occurred in nine patients (15%); nonfatal recurrent infarction was noted in one (1.7%). Four patients (6.7%) experienced major bleeding, including one with intracranial bleeding. There were seven deaths (11.7%). Mortality was significantly influenced by the occurrence of cardiogenic shock, which was present in five patients at the time of enrollment. Blood fibrinogen levels were obtained before and during rt-PA infusion. At baseline and 30 and 150 min after the bolus dose, the mean fibrinogen level (+/- SD) was 284.83 +/- 77.39, 237.96 +/- 76.92 and 192.04 +/- 57.82 mg/dl, respectively. Compared with the baseline value, there was a significant (p less than 0.05) decrease in fibrinogen at both 30 and 150 min.(ABSTRACT TRUNCATED AT 250 WORDS)
McKendall
G R
GR
Department of Medicine, Rhode Island Hospital, Brown University, Providence 02903.
Attubato
M J
MJ
Drew
T M
TM
Feit
F
F
Sharaf
B L
BL
Thomas
E S
ES
Teichman
S
S
McDonald
M J
MJ
Williams
D O
DO
D000328:Adult; D002985:Clinical Protocols / Q000592:standards; D017023:Coronary Angiography; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D005340:Fibrinogen / Q000737:chemistry; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009519:New York City / Q000453:epidemiology; D012008:Recurrence; D012237:Rhode Island / Q000453:epidemiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects
D005340:Fibrinogen; D010959:Tissue Plasminogen Activator