title: Alteplase: double bolus versus accelerated regimen.
abstract: BACKGROUND
  The purpose of our study was to compare the efficacy and safety of alteplase in acute myocardial infarction (AMI), when administered in a double bolus regimen or an accelerated regimen during admission to an intensive care or coronary care unit (ICU/CCU).
  
  
  METHODS
  A retrospective cohort study including all the AMI patients treated with alteplase recorded in the ARIAM register (Analysis of Delay in AMI), a multi-center register in which 77 Spanish hospitals participate. The study period was from January 1995 to January 2000.
  
  
  RESULTS
  4,615 AMI patients were studied. The accelerated regimen (Group I) was administered to 57.51% (2,654 patients) and the remaining 42.49% (1,961 patients) received the double bolus regimen (Group II). There were no differences in mortality or in the incidence of hemorrhagic stroke between the groups. The mortality was 7.15% in Group I versus 6.43% in Group II (not significant). The incidence of hemorrhagic stroke was 1.09% in Group I versus 1.22% in Group II (not significant). Fewer coronary angiographies were required in Group I (6.28% vs. 8.99%; p<0.001) and fewer rescue angioplasties (10.67% vs. 21.88%, p=0.03). Group I also showed a smaller requirement for stent insertion (2.45% vs. 4.77%; p<0.0001) and for assistance using intra-aortic balloon contrapulsation (0.47% vs. 1.36%; p=0.02).
  
  
  CONCLUSIONS
  The two regimens appear to be similar in efficacy and safety. Nevertheless, from these results it may be hypothesized that further revascularization techniques are required after double bolus administration.
authors.affiliation: Intensive Care Unit, Critical Care and Emergency Department, Hospital de Poniente, El Ejido, Almería, Spain. mrb1604@teleline.es
authors.forename: Manuel
authors.initials: M
authors.lastname: Ruiz-Bailén
authors.forename: Eduardo
authors.initials: E
authors.lastname: Aguayo de Hoyos
authors.forename: Benjamín
authors.initials: B
authors.lastname: Hurtado-Ruiz
authors.forename: Antonio
authors.initials: A
authors.lastname: Reina-Toral
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Díaz-Castellanos
authors.forename: Ziad
authors.initials: Z
authors.lastname: Issa-Khozouz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator