Summary of early clinical experience with anisoylated plasminogen streptokinase activator complex in the treatment of acute myocardial infarction.
Preliminary investigations using a single intracoronary dose of APSAC (up to 30U) revealed dissolution of intracoronary thrombi in 59 of 83 patients (71%) with acute myocardial infarction, as indicated by reperfusion of coronary arteries. Reocclusion of arteries occurred in 20.5% of patients. Based on these findings, a subsequent study was undertaken in 302 patients with evidence of recent acute myocardial infarction. Single intravenous bolus doses of APSAC (5 to 30U) produced reperfusion in 79% of patients, with reocclusion occurring in only 9% of patients receiving the higher doses. Adverse effects included an initial hypotension/bradycardia reaction, a later syndrome featuring pyrexia, nausea and vomiting, and bleeding complications, including 4 patients with cerebrovascular accidents. In these early studies APSAC appeared to be as effective as streptokinase, as reported in the literature, and to produce a lower incidence of reocclusion than tissue plasminogen activator.
Jackson
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Beecham Pharmaceuticals Research Division, Brockham Park, Betchworth.
D016255:Anistreplase; D006328:Cardiac Catheterization; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007275:Injections, Intravenous; D009203:Myocardial Infarction / Q000188:drug therapy*; D010958:Plasminogen / Q000009:adverse effects / Q000627:therapeutic use*; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D016255:Anistreplase; D010958:Plasminogen; D013300:Streptokinase