Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation

The ability of anisoylated plasminogen: streptokinase activator complex (APSAC) to induce coronary artery reperfusion after bolus intravenous injection (2 to 4 minutes) was assessed in 29 ...

Rapid Lysis of Coronary Artery Thrombi with Anisoylated Plasminogen: Streptokinase Activator Complex

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02552-6.pdf

Risk of intracranial haemorrhage with bolus versus infusion thrombolytic therapy: a meta-analysis.

A controlled trial in149patients admitted toadistrict hospital withprobable myocardial infarction tested theeffect of30units ofanisoylated plasminogen streptokinase activator complex (APSAC)onindices ofinfarct size. Patients weregrouped prospectively according towhether theyentered thetrial within twoandahalf hours (early entry) orbetween twoandahalf and four hours (late entry) after onset ofthesymptoms. Sixty seven of 73patients inthecontrol group showedincreased plasma activity ofmyocardial creatine kinase isoenzyme that wasdiagnostic of infarction compared withonly60of76whoreceived APSAC. Thedifference wassignificant overall butoccurred predominantly intheearly entry group. Thepatients whoreceived APSAChadmoreearly ventricular arrhythmias, compatible with reperfusion, andshowedgreater preservation ofRwavesduring admission tohospital. Unwanted effects weregenerally minor andmorecommonintheactively managed group thanthecontrol group (26%v3%).After nine to12months offollow up12patients inthecontrol group haddiedcompared withseven intheactively managed group. Theeaseofadministration andtheapparent efficacy of APSACsuggest that itissuitable foruseinadistrict hospital for patients withsuspected acute myocardial infarction.

Treatment ofacute myocardial infarction withanisoylated plasminogen streptokinase activator complex

Aims Thrombolytic therapy has been known to be effective in reducing clinical outcomes and increasing recanalization rate among patients with ST-segment elevation acute myocardial infarction (STEMI). However, whether post-thrombolysis recanalization could be used as a surrogate for clinical outcomes is unknown. Methods We systematically searched PubMed, EMBASE and the Cochrane Library database to identify randomized controlled trials (RCT) that examined effects of thrombolytic agents in STEMI. Recanalization was defined as TIMI grade 2 or 3 flow. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included in-hospital and 30-day recurrent myocardial infarction (re-MI), composite of death and re-MI, major bleeding and all bleeding. Random-effects meta-regression was used for analysis. Results We identified 111 eligible study arms and 52 eligible comparisons from 58 RCTs involving 16 536 patients. Our analyses showed that among study arms recanalization rate was significantly inversely associated with the incidence of in-hospital all-cause mortality (β: -0.07, 95% confidence interval [CI]: -0.13 to -0.02), re-MI (β: -0.09, 95%CI: -0.18 to -0.01) and the composite of death and re-MI (β: -0.17, 95%CI: -0.28 to -0.05), and positively associated with in-hospital all bleeding but not with major bleeding. Among paired comparisons, the difference in recanalization rate was associated with the corresponding difference in incidence of in-hospital all-cause mortality (β: -0.15, 95%CI: -0.28 to -0.01) but the relationship was not significant for any other outcome. Conclusion Pooled evidence from RCTs suggest the potential use of recanalization as a surrogate for clinical outcomes in evaluating the efficacy of thrombolysis among patients with STEMI.

The recanalization after thrombolysis as surrogate for clinical outcomes in patients with ST-segment elevation acute myocardial infarction: A systematic review and meta-regression analysis of data from randomized controlled trials

This randomized study compares the coronary perfusion rate in patients with acute myocardial infarction (AMI) treated with 2 different intravenous thrombolytic agents: streptokinase 1.5 million U given over 60 minutes and anisoylated human plasminogen streptokinase activator complex (anistreplase) administrated as a bolus of 30 U over 5 minutes. One hundred seventy-five patients (149 men and 26 women, mean age 54 years) have been included in this study. Eighty-nine patients were treated with anistreplase and 86 patients with streptokinase. AMI was inferior in 54 patients (61%) in the anistreplase group and in 54 patients (63%) in the streptokinase group. It was anterior in 35 (40%) and 32 (37%) patients, respectively. Coronary angiography and ventriculography were performed at a mean time (+/- SEM) of 207 +/- 11 minutes after the beginning of thrombolysis in 170 patients. A perfusion score grade of 2 or 3 according to the Thrombolysis in Myocardial Infarction trial was found in 63 patients (72%) in the anistreplase group and in 56 patients (68%) in the streptokinase group (p = NS). Severe bleeding occurred in 7 patients (8%) after anistreplase and in 6 patients (7%) after streptokinase. No cerebral hemorrhage occurred. Nine patients (5%) died during their hospital stay: 6 after anistreplase and 3 after streptokinase. It is concluded that intravenous administration of anistreplase or streptokinase is efficient and safe. Coronary patency 207 minutes after fibrinolysis, incidence of adverse events and mortality are similar in both groups.

Comparison of results of intravenous infusion of anistreplase versus streptokinase in acute myocardial infarction.

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Comparison of results of intravenous infusion of anistreplase versus streptokinase in acute myocardial infarction.