Continuous rt-PA infusion as a salvage strategy to maintain patency of the infarct artery; safety of high cumulative dose and subsequent emergency coronary artery angioplasty and bypass surgery.
Acute re-occlusion of an infarct artery reperfusion attained by thrombolytic therapy may be treated by emergency coronary angioplasty or bypass surgery. Repeated infusion of a thrombolytic agent is an additional treatment strategy. Three patients with reinfarctions that occurred very early after successful reperfusion were treated with continuous infusion of recombinant tissue-type plasminogen activator (rt-PA). These patients received a rt-PA dose of 300-360 mg while they awaited emergency mechanical revascularization procedures. Two patients had coronary angioplasty immediately after receiving repeated infusions of rt-PA and one underwent coronary bypass surgery while receiving a third rt-PA infusion. There were no bleeding complications in the 2 patients who underwent coronary angioplasty, and no excessive bleeding in the patient who received coronary bypass surgery. Thus, repeated continuous rt-PA infusions can be used to maintain the patency of recurrently occluding infarct arteries until definitive mechanical revascularization can be performed.
Barbash
G I
GI
Cardiology Department, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Hod
H
H
Faibel
H E
HE
Ziskind
Z
Z
Agranat
O
O
Hirsh
R
R
Schlezinger
Z
Z
Smolinsky
A
A
D000328:Adult; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery*; D003422:Critical Care / Q000379:methods; D006801:Humans; D007238:Infarction / Q000188:drug therapy* / Q000503:physiopathology; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator