Intravenous Recombinant Tissue Plasminogen Activator (rt-PA) and Urokinase in Acute Myocardial Infarction: Results of the German Activator Urokinase Study (GAUS)

Abstract

The effects of recombinant tissue plasminogen activator (rt-PA) and urokinase on patency and early reocclusion of infarct-related coronary arteries were investigated in a single blind, randomized multicenter trial in 246 patients with acute myocardial infarction of less than 6 h duration. Both 70 mg of single chain rt-PA with an initial bolus of 10 mg and 3 million units of urokinase with an initial bolus of 1.5 million units were given intravenously over 90 min. The first angiographic study at the end of the infusion revealed a patent infarct-related artery (Thrombolysis in Myocardial Infarction trial [TIMI] grade 2 or 3) in 69.4% of 121 patients given rt-PA versus 65.8% of 117 patients given urokinase (p = NS). Among patients treated within 3 h from symptom onset a patent infarct-related artery was found in 63.9% of 72 patients given rt-PA versus 70% of 70 patients given urokinase (p = NS). There were five cardiac deaths in each group and one fatal intracranial hemorrhage in the rt-PA group. The in-hospital reinfarction rate was 8.9% versus 13.2% for patients treated with rt-PA and urokinase, respectively. There was no difference in left ventricular function at baseline and follow-up catheterization studies. Both drugs were well tolerated and there was no significant difference in cardiovascular or bleeding complications between the two groups. It is concluded that rt-PA and urokinase in the dosages used provide similar efficacy and safety in the treatment of acute myocardial infarction. Reocclusion during the first 24 h may be less frequent after urokinase treatment.

Predischarge ST Segment and T Wave Patterns in Predicting Left Ventricular Function and Myocardial Viability in Q Wave Anterior Myocardial Infarction Patients

“…In many studies, different degrees of reperfusion have been shown between the acute and subsequent phases of myocardial infarction in patients treated with thrombolysis. 24) Therefore, the predischarge ECG may be a better predictor for reperfusion and left ventricular function. Kusniec, et al found that both an isoelectric ST segment and a negative T wave on the predischarge ECG were significantly associated with a higher patency of the infarct-related artery (TIMI flow grade 3), and suggested this pattern as a better marker for reperfusion.…”

Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke.

“…Alteplase was given as a 15 mg bolus, followed by 50 mg over 30 minutes and 35 mg over the subsequent 60 minutes, as adopted from a German rt-PA-myocardial infarction study. 21 Simultaneously with the alteplase, we injected a bolus of 5,000 units heparin and continued the heparin by infusing 1,000-1,500 units/hr, aiming to double the activated partial thromboplastin time (aPTT) in each patient. Heparin was discontinued when CT revealed parenchymal hemorrhage.…”

Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. Relevance for the success of therapy.

“…When differentially analyzed for clinical course (persistent patency, nonsuccessful thrombolysis, or early reocclusion), marked differences among the three groups, however, were found. Rapid normalization occurred in patients with successful thrombolysis, and steady increases in TAT levels occurred in patients who did not undergo successful thrombolysis or who suffered reocclusion of the infarcted artery within [24][25][26][27][28][29][30][31][32][33][34][35][36] hours. To interfere with the activation process of thrombin, intravenous heparin was given to all patients enrolled in the study.…”