| Autor: |
Turi ZG; Cardiac Catheterization Laboratory, Harper Hospital/Wayne State University School of Medicine, Detroit, Michigan 48201., Goldberg S, LittleJohn JK, Vander Ark C, Shadoff N, Karlsberg R, Williams J, Butman S, Stadius ML, Wise K, et. al. |
| Jazyk: |
angličtina |
| Zdroj: |
The American journal of cardiology [Am J Cardiol] 1993 May 01; Vol. 71 (12), pp. 1009-14. |
| DOI: |
10.1016/0002-9149(93)90564-s |
| Abstrakt: |
Although the efficacy of recombinant tissue-type plasminogen activator (rt-PA) in acute myocardial infarction has been demonstrated, little formal dose-ranging information is available. This study examined the use of duteplase, the double-chain rt-PA subsequently used in the Third International Study of Infarct Survival, in a multicenter trial of 267 patients with evolving acute myocardial infarction assigned to receive 1 of 6 weight-adjusted doses. The primary end point was infarct vessel patency after 90 minutes of drug infusion. Patency was defined as Thrombolysis in Myocardial Infarction trial grade 2 or 3 perfusion, and was determined by an independent core laboratory masked to treatment assignment. Patency was present in 48% of patients receiving the lowest dose range and 78% of those receiving the highest, with an association between thrombolytic dose and patency (p = 0.009). The frequency of serious bleeding complications also correlated with the total dose of rt-PA infused (p = 0.003). Bleeding complications were primarily related to instrumentation; blood loss requiring transfusion or otherwise deemed clinically significant occurred in 12% of patients (central nervous system hemorrhage occurred in 1.1%). Thus, higher doses of rt-PA are associated both with increased efficacy and increased risk of serious bleeding complications. Weight-adjusted dosing may provide an optimal risk-benefit ratio for thrombolysis during acute myocardial infarction. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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