[Thrombolysis in acute myocardial infarct].
Thrombolysis for acute myocardial infarction is based on the discovery some 80 years ago that the total occlusion of a coronary artery is universally due to a thrombus. In the eighties, thrombolysis has become established as the therapy of choice for infarction, and its value has since been proved in large randomized studies. First, the ISIS-2 study showed the efficacy of streptokinase alone and in combination with aspirin in reducing mortality. The GISSI study corroborated these data. The ISIS-3 study and the GISSI-2 study (complemented by the International Study) failed to show a difference in efficacy between TPA and streptokinase. Anistreplase (APSAC) proved inferior to the other two drugs. The GUSTO study (over 40,000 patients) revealed a minor advantage of an accelerated regimen of TPA compared with the usual streptokinase dose. TPA was combined with intravenous heparin. According to the data gathered in American centers, about one life could be saved per 100 patients treated albeit at the considerably higher price of the TPA. European data suggest that it may only be one life saved per 200 treated patients. The main complication of thrombolysis is bleeding. The more efficient the thrombolytic treatment is, the higher the bleeding rate. Cerebral insults (particularly hemorrhages) are increased in patients with thrombolysis complemented by aspirin and heparin. However, these complications do not completely forfeit the beneficial effect of the two adjunctive medications on cardiac mortality. It has emerged that intravenous heparin is not essential in the first hour of TPA treatment but because important thereafter, whereas it may be essential in the first hour of streptokinase treatment but deleterious thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)
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Departement Medizin, Universitätsklinik, Inselspital, Bern.
D000367:Age Factors; D000075202:Contraindications; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D013300:Streptokinase; D010959:Tissue Plasminogen Activator
Thrombolyse beim akuten Myokardinfarkt.