Heparin and infarct coronary artery patency after streptokinase in acute myocardial infarction

Mahan, Edward F.; Chandler, Jerry W.; Rogers, William J.; Nath, Hrudaya R.; Smith, L R; Whitlow, Patrick L.; Hood, William P.; Reeves, Robert L.; Baxley, William A.

doi:10.1016/0002-9149(90)90998-g

Cited by 16 publications

(2 citation statements)

References 26 publications

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“…A large intravenous bolus dose of heparin alone, without a fibrinolytic, led in a very small study of 14 patients to a TIMI 2 and 3 grade flow at 90 minutes in 71% of patients and to a grade 3 flow in 64%, comparable with the results obtained with therapeutic thrombolysis [36]. A few small studies have also suggested that heparin could accelerate the lytic effect of streptokinase [37] and help maintain patency of the open artery [38]. One study randomized 711 patients with acute myocardial infarction to calcium-heparin, 12,500 U every 12 hours, or no heparin, and reported a mortality reduction with treatment from 10% to 8.6% (p = 0.03) [39]; the 433 patients who received streptokinase in this study also showed a statistically significant benefit, with mortality reduced to 4.6% from 8.8% (p = 0.05).…”

Section: Heparinmentioning

confidence: 84%

Enhancing thrombolysis with adjunctive therapy

Théroux

1996

J Thromb Thrombol

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The striking clinical benefits that can be derived from thrombolytic therapy in acute myocardial infarction emphasize the need for further improvement of our reperfusion strategies. New approaches in that direction include the development of more efficient thrombolytic drugs as well as an adjunctive therapy to control the ongoing thrombogenic stimulation. Aspirin is already useful in this regard as well as heparin with recombinant tissue-type plasminogen activator. The field of antithrombotic therapy is rapidly expanding with the development of patent drugs targeted at inhibiting specific steps of platelet activation and of the coagulation cascade. This new therapy provides opportunities to better understand the pathophysiological processes involved in acute ischemic syndromes and to modulate them. This article reviews the adjunctive antithrombotic therapy currently available or under clinical investigation with the potential of enhancing the benefits of thrombolysis.

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Section: Heparinmentioning

confidence: 84%

Enhancing thrombolysis with adjunctive therapy

Théroux

1996

J Thromb Thrombol

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“…The optimal duration of heparin therapy after thrombolysis is unknown but appears to be at least 24 hours. [39][40][41][42][43] Heparin infusion was, thus, required to be administered for at least 24 hours after dosing (the time of repeated angiogram) and adjusted to keep partial thromboplastin time or thrombin time at about two to three times the upper limit of the normal range. In this study, which was begun before the results of the International Study of Infarct Survival (ISIS-2) were known, aspirin or other antiplatelet therapy was not routinely administered within 24 hours of thrombolytic therapy.…”

Section: Ancillary Medicationsmentioning

confidence: 99%

Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. The TEAM-2 Study Investigators.

et al. 1991

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Thrombolytic therapy has been shown to improve clinical outcome when administered early after the onset of symptoms of acute myocardial infarction; the mechanism of benefit is believed to be reestablishment and maintenance of coronary artery patency. Anistreplase is a second generation thrombolytic agent that is easily administered and has a long duration of action. To compare anistreplase (30 units/2-5 min) and therapy with the Food and Drug Administration-approved regimen of intravenous streptokinase (1.5 million units/60 min), a randomized, double-blind, multicenter patency trial was undertaken in 370 patients less than 76 years of age with electrocardiographic ST segment elevation who could be treated within 4 hours of symptom onset. Coronary patency was determined by reading, in a blinded fashion, angiograms obtained early (90-240 minutes; mean, 140 minutes) and later (18-48 hours; mean, 28 hours) after beginning therapy. Early total patency (defined as Thrombolysis in Myocardial Infarction grade 2 or 3 perfusion) was high after both anistreplase (132/183 = 72%) and streptokinase (129/176 = 73%) therapy, and overall patency patterns were similar, although patent arteries showed "complete" (grade 3) perfusion more often after anistreplase (83%) than streptokinase (72%) (p = 0.03). Similarly, residual coronary stenosis, determined quantitatively by a validated computer-assisted method, was slightly less in patent arteries early after anistreplase (mean stenosis diameter, 74.0%) than streptokinase (77.2%, p = 0.02). In patients with patent arteries without other early interventions, reocclusion risk within 1-2 days was defined angiographically and found to be very low (anistreplase = 1/96, streptokinase = 2/94). Average coronary perfusion grade was greater, and percent residual stenosis was less, at follow-up than on initial evaluation and did not differ between treatment groups. Enzymatic and electrocardiographic evolution was not significantly different in the two groups. Despite rapid injection, anistreplase was associated with only a small (4-5 mm Hg), transient (at 5-10 minutes) mean differential fall in blood pressure. In-hospital mortality rates were comparable for anistreplase and streptokinase (5.9%, 7.1%). Stroke occurred in one (0.5%) and three (1.6%) patients, respectively; one stroke was hemorrhagic. Other serious bleeding events and adverse experiences occurred uncommonly and with similar frequency in the two groups. Thus, for the end points of our study (patency, safety), anistreplase and streptokinase showed overall favorable and relatively comparable outcomes, with a few differences.(ABSTRACT TRUNCATED AT 400 WORDS)

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Heparin and myocardial infarction

1992

Clinical Cardiology

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Heparin and infarct coronary artery patency after streptokinase in acute myocardial infarction

Cited by 16 publications

References 26 publications

Enhancing thrombolysis with adjunctive therapy

Enhancing thrombolysis with adjunctive therapy

Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. The TEAM-2 Study Investigators.

Heparin and myocardial infarction

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