title: Improved infarct-related arterial patency after high dose, weight-adjusted, rapid infusion of tissue-type plasminogen activator in myocardial infarction: results of a multicenter randomized trial of two dosage regimens.
abstract: To determine whether a weight-adjusted high dose (2 mg/kg body weight over 3 h) rapid infusion of recombinant tissue-type plasminogen activator (rt-PA) was more efficacious than a weight-adjusted standard dose (1.25 mg/kg over 3 h) in achieving reperfusion in the setting of acute myocardial infarction, 175 patients were entered into a randomized multicenter trial. Eighty-four patients were entered into the high dose group, receiving 1.2 mg/kg (10% given as a bolus injection) over 1 h, followed by 0.8 mg/kg over the next 2 h. Ninety-one patients were given 0.75 mg/kg (10% given as a bolus injection) in 1 h, followed by 0.5 mg/kg administered over the next 2 h. The median dose in the group that received 2 mg/kg dose was 145 mg, compared with 100 mg in the group that received 1.25 mg/kg. The 90 min patency rate in the group that received 2 mg/kg was 84% compared with 70% in the group that received 1.25 mg/kg (p = 0.003). Sixty-four percent of the patients in each group underwent coronary angioplasty at the time of cardiac catheterization. The infarct-related artery patency rate at the end of catheterization was 91% in the group that received 2 mg/kg compared with 83% in the group that received 1.25 mg/kg (p = 0.08). Among patients with a patent infarct-related coronary artery after catheterization, the 6 month mortality rate in the group that received 2 mg/kg was 2.9% compared with 9.8% in the group that received 1.25 mg/kg (p = 0.15). The bleeding complication rate in the two groups was similar.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: University of Texas Medical School, Houston 77030.
authors.forename: R W
authors.initials: RW
authors.lastname: Smalling
authors.forename: R
authors.initials: R
authors.lastname: Schumacher
authors.forename: D
authors.initials: D
authors.lastname: Morris
authors.forename: K
authors.initials: K
authors.lastname: Harder
authors.forename: F
authors.initials: F
authors.lastname: Fuentes
authors.forename: R P
authors.initials: RP
authors.lastname: Valentine
authors.forename: L L
authors.initials: LL
authors.lastname: Battey
authors.forename: M
authors.initials: M
authors.lastname: Merhige
authors.forename: D E
authors.initials: DE
authors.lastname: Pitts
authors.forename: H A
authors.initials: HA
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001777:Blood Coagulation / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D010959:Tissue Plasminogen Activator