[Pilot study of the effectiveness of combination therapy with reduced dose alteplase and the glycoprotein IIb/IIIa antagonist tirofiban in acute myocardial infarct].
In a pilot study with a total of 43 patients (31 males, 12 females) at a mean age of 64.2 +/- 12.1 years, the efficacy of a combination of a reduced dosage of alteplase (50 mg) and tirofiban with a start infusion of 0.4 microgram/kg/min over half an hour and an infusion rate of 0.10 microgram/kg/min over 12 h (PRISM-PLUS, modified) in four patients and a bolus of 10 micrograms/kg over 3 minutes and an infusion rate of 0.15 microgram/kg/min over 24 h (RESTORE, modified) in 39 patients were tested in acute myocardial infarction with regard to patency of infarct vessel and TIMI flow according to coronary angiography after 60 minutes, 30-day mortality and bleeding complications. The use of tirofiban in the PRISM-PLUS dosage led to an infarct vessel patency of 25% with TIMI III flow in one case. There were no complications in the next 30 days in this group. The use of tirofiban in the RESTORE dosage led to an infarct-vessel patency of 87%, a TIMI III flow in 79%, a 30-day mortality of 2.6% and a slight PCI-associated bleeding complication in one case. The combination of alteplase in a reduced dosage and tirofiban with a single bolus and an infusion rate according to the RESTORE study with satisfactory efficacy and low complication rate seems to be useful in the management of acute myocardial infarction.
Peters
S
S
Klinik Innere Medizin Abteilung Kardiologie Klinikum Dorothea Christiane Erxleben gGmbH Quedlinburg Ditfurter Weg 24, 06484 Quedlinburg, Germany.
Trümmel
M
M
Brattström
A
A
Meyners
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D015607:Stents; D015912:Thrombolytic Therapy; D000077466:Tirofiban; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014443:Tyrosine / Q000008:administration & dosage* / Q000031:analogs & derivatives*
D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D010959:Tissue Plasminogen Activator; D000077466:Tirofiban