Rapid lysis of coronary artery thrombi with anisoylated plasminogen: streptokinase activator complex. Treatment by bolus intravenous injection

Ann Intern Med. 1986 Mar;104(3):304-10. doi: 10.7326/0003-4819-104-3-304.

Abstract

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 patients with acute transmural myocardial infarction and complete coronary artery occlusion. A 5-mg dose resulted in reperfusion in 3 of 14 patients (21%); a 5-mg plus 10-mg regimen was successful in 3 of 7 (43%); and a 30-mg dose induced reperfusion in 9 of 15 (60%). Rethrombosis occurred in only 1 of 15 patients (7%) who received 30 mg, as determined by repeat angiography at 24 hours. The mean interval after injection until reperfusion was 35 minutes with the 30-mg dose, and bleeding occurred at the femoral artery catheterization site in only 3 of 15 patients (20%). Intracoronary streptokinase therapy achieved reperfusion in only 2 of the 6 patients in whom the 30-mg dose failed, indicating that this dose of APSAC was sufficient by itself in 9 of 11 (83%) successfully treated patients. Because therapy can be completed within 2 to 4 minutes, APSAC appears to be a most suitable fibrinolytic agent for early treatment of the coronary artery thrombosis associated with acute transmural myocardial infarction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anistreplase
  • Cardiac Catheterization
  • Coronary Angiography
  • Dose-Response Relationship, Drug
  • Female
  • Fibrinogen / metabolism
  • Hemorrhage / chemically induced
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / drug therapy*
  • Plasminogen / administration & dosage
  • Plasminogen / adverse effects
  • Plasminogen / metabolism
  • Plasminogen / therapeutic use*
  • Streptokinase / administration & dosage
  • Streptokinase / adverse effects
  • Streptokinase / therapeutic use*
  • Time Factors

Substances

  • Anistreplase
  • Fibrinogen
  • Plasminogen
  • Streptokinase