Efficacy and safety of a new streptokinase regimen with enoxaparin in acute myocardial infarction.
OBJECTIVE
To compare a new streptokinase regimen combined with either enoxaparin or unfractionated heparin (UFH) and the traditional streptokinase regimen combined with UFH in patients with acute myocardial infarction (AMI).


METHODS
412 patients (<75 years), hospitalized within 6 hours of the onset of chest pain, were allocated thrombolytic therapy by the treating physician: streptokinase 0.75 MU/10 minutes, repeated if no coronary reperfusion after one dose, plus enoxaparin 40 mg intravenously followed by 1 mg/kg bodyweight subcutaneously at 12-hour intervals for 5-7 days (n = 102); the same streptokinase regimen plus UFH 1000 IU/60 minutes intravenously for 48-72 hours ( n = 106); or streptokinase 1.5 MU/60 minutes plus the same UFH regimen (n = 204). All patients received 250-325 mg aspirin/day. Coronary reperfusion rates, 30-day mortality and hemorrhagic complications were recorded.


RESULTS
Coronary reperfusion rates with 0.75 streptokinase + enoxaparin (78.4%) and 0.75 streptokinase + UFH (74.5%) were significantly higher than those with 1.5 streptokinase + UFH (62.2%), but there was no significant difference between the groups receiving the new regimen. Overall 30-day mortality (6.3%) was significantly lower than with 1.5 streptokinase + UFH (12.7%) ( p = 0.037). The incidence of major and minor hemorrhagic events was similar in all groups.


CONCLUSIONS
The accelerated streptokinase regimen was well tolerated and resulted in a significantly higher coronary reperfusion rate and significantly lower mortality compared with the traditional regimen. The 0.75 streptokinase + enoxaparin combination was at least as efficacious as the 0.75 streptokinase + UFH combination and is preferred because of its ease of administration and predictable anticoagulant effect.
Tatu-Chitoiu
Gabriel
G
Clinic of Cardiology, Emergency Hospital/Outpatient Clinic, Calea Floreasca nr. 8 sector 1, 79406 Bucharest, Romania. gabitatu@hotmail.com
Teodorescu
Cristina
C
Dan
Monica
M
Capraru
Petre
P
Guran
Manuela
M
Istratescu
Oana
O
Tatu-Chitoiu
Alexandrina
A
Bumbu
Aurelia
A
Dorobantu
Maria
M
D000368:Aged; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D015425:Myocardial Reperfusion / Q000379:methods; D013300:Streptokinase / Q000008:administration & dosage* / Q000009:adverse effects; D015996:Survival Rate
D017984:Enoxaparin; D006493:Heparin; D013300:Streptokinase