title: Repeat infusion of recombinant tissue-type plasminogen activator in patients with acute myocardial infarction and early recurrent myocardial ischemia.
abstract: When conventional treatment of patients with early clinical reinfarction after thrombolytic therapy fails, mechanical revascularization may be attempted. An alternative strategy, repeat thrombolytic infusions, is reported. Fifty-two patients with acute myocardial infarction were treated with one or two additional thrombolytic infusions of recombinant tissue-type plasminogen activator (rt-PA) because of nonsustained ischemia after initial treatment with rt-PA or streptokinase. Thirty-five patients received the second infusion within 1 h of the first; 13 patients received the second infusion 1 to 72 h after the first and 4 patients received it later during their hospitalization. Bleeding complications occurred in 10 patients (19%); however, most of these were minor (no intracranial bleeding) and only 2 patients required blood transfusion. In 14 patients in whom the decrease in fibrinogen and plasminogen levels was measured after the first and second infusions, this decrease was only 25% and 63%, respectively--only slightly higher than the 22% and 53% decreases measured in 63 patients who had only one rt-PA infusion. In 44 patients (85%), the acute ischemia resolved completely within 1 h after initiation of the second infusion. In 23 patients (44%), pain and ST segment elevation did not recur and invasive coronary intervention was avoided. Thus, repeat rt-PA infusions can stabilize a substantial number of patients with acute reinfarction and, even when relief is temporary, repeat rt-PA infusions can minimize myocardial damage while patients await mechanical revascularization.
authors.affiliation: Cardiology Institute, Sheba Medical Center, Tel Aviv, Ramat-Gan, Israel.
authors.forename: G I
authors.initials: GI
authors.lastname: Barbash
authors.forename: H
authors.initials: H
authors.lastname: Hod
authors.forename: A
authors.initials: A
authors.lastname: Roth
authors.forename: H E
authors.initials: HE
authors.lastname: Faibel
authors.forename: Y
authors.initials: Y
authors.lastname: Mandel
authors.forename: H I
authors.initials: HI
authors.lastname: Miller
authors.forename: S
authors.initials: S
authors.lastname: Rath
authors.forename: Y H
authors.initials: YH
authors.lastname: Zahav
authors.forename: B
authors.initials: B
authors.lastname: Rabinowitz
authors.forename: U
authors.initials: U
authors.lastname: Seligsohn
mesh_terms: D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator