Safety and efficacy of repeat thrombolytic treatment after acute myocardial infarction.

Abstract

Thrombolytic treatment for acute myocardial infarction increases the risk of subsequent reocclusion of the infarct related artery. The efficacy and safety of repeat thrombolytic treatment was assessed in 31 patients treated with streptokinase (n = 13) or tissue plasminogen activator (n = 18) a median of five days (1-716) after the first infusion. The The benefits of repeat thrombolytic treatment for threatened reinfarction may resemble those of the initial administration, but the risks and benefits have not been well described. We report the results of repeat thrombolytic treatment in 31 patients with threatened reinfarction. Patients and methodsWe studied 31 patients (22 men and nine women, mean (SD) age 58 (9) years) who had all been treated with intravenous thrombolysis for acute myocardial infarction. Indications for initial thrombolysis included ischaemic chest pain lasting more than 30 minutes with onset less than six hours before thrombolytic treatment and associated ST segment elevation of > 1 mm in two limb leads or V4-V6 or >2 mm in leads V1-V3. The initial thrombolytic treatment was an infusion of streptokinase 1-5 million units intravenously over 30 minutes in 23 patients and of recombinant tissue plasminogen activator 100 mg intravenously over three hours in eight patients. In all patients treatment with aspirin (50-300 mg per day) was started on admission to the coronary care unit and 12 patients were also given dipyridamole (400 mg daily

Fibrinolysis for Acute Myocardial Infarction

“…5 Within a few days, the anti-SK titer rapidly rises to 50 to 100 times the preinfusion level, remaining there for many months or even years. 13 This makes repeated administration impractical except very early after initial dosing. A new recombinant preparation of SK has recently been demonstrated to possess a similar risk/benefit profile in acute myocardial patients compared with wild-type SK.…”

Prevention of Myocardial Infarction by Nitroglycerin plus Intravenous Beta-Blockers

“…Although re-administration of throm bolytic agents could seem adequate, it is not free of severe side effects [7], so it is worth trying with nitroglycerin plus beta-blockers before. Further investigation is needed to ex tend these indications more widely, but it might be appropriate for most patients with prolonged ST-segment elevation refractory to conventional therapy.…”

“…Administration of thrombolytic agents in so early time is related to prevention of myo cardial infarction in 22-50% of cases [6][7][8].…”

High-frequency electrocardiogram as a supplement to standard 12-lead ischemia monitoring during reperfusion therapy of acute inferior myocardial infarction

“…Failed reperfusion therapy may be rescued by acute adjunctive therapies, e.g. percutaneous coronary angioplasty or administration of additional thrombolytic drugs (3,4). It is therefore of major clinical importance to rapidly detect failed reperfusion in the acute phase because additional interventions could then be indicated to re-establish blood flow to the myocardium in jeopardy.…”