[Increased efficacy of thrombolytic therapy in acute myocardial infarction by improved properties of new thrombolytic agents].
Thrombolysis is a milestone in the therapy of acute myocardial infarction due to its ubiquitous availability and ease of application. The recombinant form of tissue-type plasminogen activator (rt-PA) has been proven to be superior over first generation fibrinolytic agents (streptokinase, urokinase, APSAC) with respect to efficacy and side effects and the front-loaded regimen has meanwhile become the "gold"-standard of thrombolytic therapy. Biochemically modified mutants of wild-type t-PA, e.g. r-PA (reteplase), n-PA (lanoteplase), and TNK-t-PA have altered biochemical and pharmacokinetic characteristics which make them more easy to use (as double or single bolus injection) and share a theoretical efficacy benefit. This article describes these specific characteristics focussing on clot-selectivity and PAI-1 resistance of the new mutants of wild-type t-PA and their possible clinical efficiency.
Huber
K
K
Universitätsklinik für Innere Medizin II, Universität Wien, Osterreich. khuber@pop3.kard.akh-wien.ac.at
D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005544:Forecasting; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C081981:lanoteplase; C087896:reteplase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator