Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial
| Autor: | Ducksoo Kim, John A. Heit, Andrew P. Selwyn, Gaurav Sharma, David B. Wilson, Don Bennett, Michael L. Feldstein, Samuel Z. Goldhaber, Michael F. Meyerovitz, William R. Friedenberg, J S Nagel, John Parker, Darell E. Heiselman, Craig M. Kessler, C. Gregory Elliott |
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| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Drug Administration Schedule Cause of Death Multicenter trial Confidence Intervals medicine Humans Thrombolytic Therapy Vein Aged Urokinase business.industry Respiratory disease Thrombolysis Middle Aged medicine.disease Urokinase-Type Plasminogen Activator Recombinant Proteins Surgery Pulmonary embolism Radiography Regimen medicine.anatomical_structure Tissue Plasminogen Activator Anesthesia Acute Disease Female Pulmonary Embolism Cardiology and Cardiovascular Medicine business Plasminogen activator medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 20:24-30 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/0735-1097(92)90132-7 |
| Popis: | Thrombolysis of acute pulmonary embolism can be accomplished more rapidly and safely with 100 mg of recombinant human tissue-type plasminogen activator (rt-PA) (Activase) than with a conventional dose of urokinase (Abbokinase) given as a 4,400-U/kg bolus dose, followed by 4,400 U/kg per h for 24 h. To determine the effects of a more concentrated urokinase dose administered over a shorter time course, this trial enrolled 90 patients with baseline perfusion lung scans and angiographically documented pulmonary embolism. They were randomized to receive either 100 mg/2 h of rt-PA or a novel dosing regimen of urokinase: 3 million U/2 h with the initial 1 million U given as a bolus injection over 10 min. Both drugs were delivered through a peripheral vein.To assess efficacy after initiation of therapy, repeat pulmonary angiograms at 2 h were performed in 87 patients and then graded in a blinded manner by a panel of six investigators. Of the 42 patients allocated to rt-PA therapy, 79% showed angiographic improvement at 2 h, compared with 67% of the 45 patients randomized to urokinase therapy (95% confidence interval for the difference in these proportions [rt-PA minus urokinase] is −6.6% to 30.4%; p = 0.11). The mean change in perfusion lung scans between baseline and 24 h was similar for both treatments. Three patients (two treated with rt-PA and one with urokinase) had an intracranial hemorrhage, which was fatal in one.The results indicate that a 2-h regimen of rt-PA and a new dosing regimen of urokinase exhibit similar efficacy and safety for treatment of acute pulmonary embolism. |
| Databáze: | OpenAIRE |
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