title: [On the possibility of accelerating thrombolytic therapy in the acute phase of myocardial infarction: efficacy of and tolerance to the infusion of 1.5 million units of streptokinase in 30 minutes].
abstract: To evaluate efficacy and tolerability of the systemic infusion of 1,500,000 streptokinase units in 30', we treated 26 consecutive patients with acute myocardial infarction within 3 hours of the onset of chest pain. They were 23 men and 3 women, mean age was 59 +/- 8 years. None of them had a history of previous myocardial infarction. From clinical and electrocardiographic data, as well as from creatine kinase curves, we assumed myocardial reperfusion in 19 patients (73%). Within 30' after infusion, thrombin time increased to more than 300" in 25/26 patients (96%). Streptokinase induced hypotension (which we defined as a decrease in systolic blood pressure of more than 30 mmHg) in 13 patients (50%), and in 5 of them (19%) systolic blood pressure fell below 90 mmHg. Hypotension was counteracted by adopting the Trendelenburg position in 7 patients, and by an intravenous infusion of atropine in 5. In the remaining patient, streptokinase infusion was slowed down. Due to these interventions, a non-significant decrease in systolic blood pressure was observed from 129 +/- 26 to 112 +/- 20 mmHg at the end of the infusion. Streptokinase-induced hypotension was not predicted either by clinical, or electrocardiographic, or chest X-ray film data, or laboratory findings. No other side-effects occurred. Hence, the infusion of 1,500,000 streptokinase units in 30' in the acute phase of myocardial infarction is active, and well tolerated. It must be emphasized, however, that during the infusion, hypotension occurs frequently and unpredictably, sometimes reaching alarm levels. This makes the monitoring of systolic blood pressure imperative during streptokinase infusion.
authors.affiliation: Divisione di Cardiologia, E.O. Ospedali Galliera, Genova.
authors.forename: G
authors.initials: G
authors.lastname: Mazzotta
authors.forename: G
authors.initials: G
authors.lastname: Cavazzana
authors.forename: A
authors.initials: A
authors.lastname: Camerini
authors.forename: G
authors.initials: G
authors.lastname: Lupi
authors.forename: C
authors.initials: C
authors.lastname: Vecchio
mesh_terms: D000328:Adult; D000368:Aged; D004341:Drug Evaluation; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D013300:Streptokinase / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D013300:Streptokinase
vernacular_title: Sulla possibilità di velocizzare l'intervento trombolitico nella fase acuta dell'infarto miocardico: efficacia e tollerabilità dell'infusione di 1.5 milioni di unità di streptochinasi in 30 minuti.