A pilot study on bolus administration of recombinant staphylokinase for coronary artery thrombolysis.
Recombinant staphylokinase (Sak) is a highly fibrin-specific thrombolytic agent but the optimal dose and mode of administration remain to be defined. Intravenous (i.v.) infusion over 5 min of 20 mg Sak in 12 patients with acute myocardial infarction induced complete coronary patency (TIMI perfusion grade 3) in 7 patients (58%) within 60 min. In 3 of the 5 patients with no or suboptimal flow (TIMI grade 0, 1 or 2) at 60 min, an additional 10 mg i.v. bolus of Sak resulted in TIMI grade 3 flow at 90 min. No major treatment-related complication occurred. Residual fibrinogen and alpha 2-antiplasmin levels at 90 min were 110 +/- 6.0% and 98 +/- 4.1% (mean +/- SEM) of baseline, respectively. Median antibody-related Sak-neutralizing activity was low at baseline (0.0 microgram/ml) and after 1 week (0.5 microgram/ml) but increased from day 10 on (to 4.0 micrograms/ml). Thus, bolus thrombolysis with Sak may induce efficient coronary artery recanalization while preserving circulating fibrinogen and alpha 2-antiplasmin. Comparative trials of coronary thrombolysis with double-bolus Sak appear to be warranted.
Center for Molecular and Vascular Biology, University of Leuven, Belgium.
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S
Vanderschueren
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D
Collen
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F
van de Werf
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000187:drug effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008666:Metalloendopeptidases / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D008666:Metalloendopeptidases; C022653:auR protein, Staphylococcus aureus