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From 1980 to 1990 we treated 100 cases of AMI with i.v. urokinase (UK). According to the way of management and the dosage administered all these cases were divided into three groups: first stage of small dosage, second stage of trial big dosage, and third stage of comprehensive dosage. 36 patients of the first stage were treated with small dosage, 1–20000 U b.i.d. for 1 week. 75 % of the UK-treated and only 17 % of the control group obtained relief of pain. Decrease of elevated ST reaching base line was 50 vs 8 %, and FDP increased in 94 %. 22 patients of the second stage were undergoing trial of big dosage. They were subdivided into larger dosage (more than 800000 U) and smaller dosage (less than 300000 U) groups. From the larger dosage group, 2 patients showed definite sign of recanalization, but unexpectedly 2 patients died of cardiac rupture. Since the recanalization rate of larger dosage group was 42.9 %, but no case showed sign of recanalization in smaller dosage group, we are of the opinion that the dose of 800000 U is rational for patients with symptoms’ onset less than 3 h. Cardiac rupture was thought to be mostly due to reperfusion injury. Thus we designed the third stage of comprehensive dosage of UK. In this stage we used different dosage of UK and different ways of administration in 52 patients, based on the different symptoms’ onset, so as to bring the effect of UK in full play. The aim of using UK is chiefly fibrinolysis as well as improvement of blood viscosity. In this stage the beneficial effects of UK may be achieved in different ways. Relief of pain and dropping down of ST segment were significantly prominent in all three groups in comparison with the control group, but there was no significant difference between the 3 stages. |
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