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CANNON, C. P; GIBSON, C. M; STEINGART, R. M; WEAVER, W. D; DE WERF, F. V; BRAUNWALD, E; MCCABE, C. H; ADGEY, A. A. J; SCHWEIGER, M. J; SEQUEIRA, R. F; GROLLIER, G; GIUGLIANO, R. P; FREY, M; MUELLER, H. S
Circulation (New York, N.Y.), 12/1998, Letnik: 98, Številka: 25Journal Article
Background —Bolus thrombolytic therapy is a simplified means of administering thrombolysis that facilitates rapid time to treatment. TNK-tissue plasminogen activator (TNK-tPA) is a highly fibrin-specific single-bolus thrombolytic agent. Methods and Results —In TIMI 10B, 886 patients with acute ST-elevation myocardial infarction presenting within 12 hours were randomized to receive either a single bolus of 30 or 50 mg TNK-tPA or front-loaded tPA and underwent immediate coronary angiography. The 50-mg dose was discontinued early because of increased intracranial hemorrhage and was replaced by a 40-mg dose, and heparin doses were decreased. TNK-tPA 40 mg and tPA produced similar rates of TIMI grade 3 flow at 90 minutes (62.8% versus 62.7%, respectively, P =NS); the rate for the 30-mg dose was significantly lower (54.3%, P =0.035) and was 65.8% for the 50-mg dose ( P =NS). A prespecified analysis of weight-based TNK-tPA dosing using median TIMI frame count demonstrated a dose response ( P =0.001). Similar dose responses were observed for serious bleeding and intracranial hemorrhage, but significantly lower rates were observed for both TNK-tPA and tPA after the heparin doses were lowered and titration of the heparin was started at 6 hours. Conclusions —TNK-tPA, given as a single 40-mg bolus, achieved rates of TIMI grade 3 flow similar to those of the 90-minute bolus and infusion of tPA. Weight-adjusting TNK-tPA appears to be important in achieving optimal reperfusion; reduced heparin dosing appears to improve safety for both agents. Together with the safety results from the parallel Assessment of the Safety of a New Thrombolytic: TNK-tPA (ASSENT I) trial, an appropriate dose of this single-bolus thrombolytic agent has been identified for phase III testing.
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Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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