Comparison of Saruplase and Alteplase in Acute Myocardial Infarction

Bär, Frits W.; Meyer, Jürgen; Vermeer, Frank; Michels, Rolf; Charbonnier, B; Haerten, K; Spiecker, Martin; Macaya, Carlos; Hanssen, M.; Heras, Magda; Boland, Jessica L.; Morice, Marie‐Claude; Dunn, Francis G.; Uebis, R.; Hamm, Christian W.; Ayzenberg, Oded; Strupp, Gerhard; Withagen, Adrie J.; Klein, W.; Windeler, Jürgen; Hopkins, Gwyn; Barth, H.; Fisenne, Michael J.M. von

doi:10.1016/s0002-9149(97)89274-0

Cited by 56 publications

(7 citation statements)

References 22 publications

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“…Mean delay from onset of symptoms to hospital admission was on average 90 minutes, a delay that correlates well with results of other trials in patients with acute myocardial infarction in Europe,24 25 and compares favourably to the delay observed in the global use of strategies to open occluded coronary arteries (GUSTO IIb) trial 13. This is of importance because the efficacy of reperfusion strategies is strongly dependent on total ischaemia time.…”

Section: Discussionsupporting

confidence: 83%

Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study

Vermeer¹,

Ophuis²,

Berg³

et al. 1999

Heart

233

100

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Objective-To assess the safety and feasibility of acute transport followed by rescue percutaneous transluminal coronary angioplasty (PTCA) or primary PTCA in patients with acute myocardial infarction initially admitted to a hospital without PTCA facilities. Design-In a multicentre randomised open trial, three regimens of treatment of acute large myocardial infarction were compared for patients admitted to hospitals without angioplasty facilities: thrombolytic treatment with alteplase (75 patients), alteplase followed by transfer to the PTCA centre and (if indicated) rescue PTCA (74 patients), or transfer for primary PTCA (75 patients). Results-Between 1995 and 1997 224 patients were included. Baseline characteristics were distributed evenly. Transport to the PTCA centre was without severe complications in all patients. Mean (SD) delay from onset of symptoms to randomisation was 130 (75) minutes and from randomisation to angiography 90 (25) minutes. Death or recurrent infarction within 42 days occurred in 12 patients in the thrombolysis group, in 10 patients in the rescue PTCA group, and in six patients in the primary PTCA group. These diVerences were not significant. Conclusions-Acute transfer for rescue PTCA or primary PTCA in patients with extensive myocardial infarction is feasible and safe. EYcacy of rescue PTCA or primary PTCA in this setting will have to be tested in larger series before this approach can be implemented as "routine treatment" for patients with extensive myocardial infarction. (Heart 1999;82:426-431)

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Section: Discussionsupporting

confidence: 83%

Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study

Vermeer¹,

Ophuis²,

Berg³

et al. 1999

Heart

233

100

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“…Thus, there is growing interest in the potential use of adjunctive intracoronary fibrinolytic therapy during primary PCI ( 24 ). Like saruplase, recombinant human pro-urokinase (pro-UK) has structural similarities to alteplase and can be converted into active urokinase on the thrombus surface to produce thrombolytic effects ( 25 , 26 ). However, to our knowledge, no previous investigations have evaluated the potential benefits of administering intracoronary pro-UK during primary PCI.…”

Section: Introductionmentioning

confidence: 99%

Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial

Huang

Qian

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: To determine whether intracoronary pro-urokinase or tirofiban improves myocardial reperfusion during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).Methods: The study included patients with acute STEMI presenting within 12 h of symptoms at 11 hospitals in China between November 2015 and July 2017. Patients were randomized to receive selective intracoronary infusion of recombinant pro-urokinase (20 mg), tirofiban (10 μg/kg), or saline (20 mL) proximal to the infarct-related lesion over a 3-min period before stent implantation during primary PCI. The primary outcome was final corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) after PCI.Results: This study included 345 patients. Initial angiography identified a high-grade thrombus (TIMI 4–5) in 80% of patients. Final CTFC after PCI was significantly lower in the pro-urokinase (P < 0.001) and tirofiban (P < 0.001) groups than in the saline group and similar between the pro-urokinase and tirofiban groups (P > 0.05). The pro-urokinase (P = 0.008) and tirofiban groups (P = 0.022) had more complete ST-segment resolution at 2 h and lower peak creatine kinase-MB levels after PCI than the saline group (P = 0.006 and P = 0.023). The 30-day incidence of major adverse cardiac events was 4.5% in the pro-urokinase group, 3.4% in the tirofiban group, and 2.6% in the saline group. The incidence of in-hospital TIMI major bleeding events was low and comparable between groups.Conclusions: Adjunctive intracoronary pro-urokinase or tirofiban given before stent implantation during primary PCI improves myocardial reperfusion without increasing the incidence of major bleeding events.

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“…The first study to compare rtPA and uPA in ischaemic stroke patients showed comparable effectivity, safety, and recanalisation rates (Terashi et al 1990). A subsequent comparative analysis of pro-uPA and rtPA in patients with acute myocardial infarction (AMI) demonstrated similar rates of patency, reocclusion, and ICH between both treatment groups (Bar et al 1997).…”

Section: Pro-upa/upa Versus Rtpamentioning

confidence: 99%

Urokinase Plasminogen Activator: A Potential Thrombolytic Agent for Ischaemic Stroke

Kadir

Bayraktutan

2019

Cell Mol Neurobiol

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Stroke continues to be one of the leading causes of mortality and morbidity worldwide.Restoration of cerebral blood flow by recombinant plasminogen activator (rtPA) with or without mechanical thrombectomy is considered the most effective therapy for rescuing brain tissue from ischaemic damage, but this requires advanced facilities and highly skilled professionals, entailing high costs, thus in resource-limited contexts urokinase plasminogen activator (uPA) is commonly used as an alternative. This literature review summarises the existing studies relating to the potential clinical application of uPA in ischaemic stroke patients.In translational studies of ischaemic stroke, uPA has been shown to promote nerve regeneration and reduce infarct volume and neurological deficits. Clinical trials employing uPA as a thrombolytic agent have replicated these favourable outcomes and reported consistent increases in recanalisation, functional improvement, and cerebral haemorrhage rates, similar to those observed with rtPA. Single-chain zymogen pro-urokinase (pro-uPA) and rtPA appear to be complementary and synergistic in their action, suggesting that their co-administration may improve the efficacy of thrombolysis without affecting the overall risk of haemorrhage. Large clinical trials examining the efficacy of uPA or the combination of pro-uPA and rtPA are desperately required to unravel whether either therapeutic approach may be a safe first-line treatment option for patients with ischaemic stroke. In light of the existing limited data, thrombolysis with uPA appears to be a potential alternative to rtPA-mediated reperfusive treatment due to its beneficial effects on the promotion of revascularisation and nerve regeneration.

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Comparison of Saruplase and Alteplase in Acute Myocardial Infarction

Cited by 56 publications

References 22 publications

Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study

Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study

Effects of Intracoronary Pro-urokinase or Tirofiban on Coronary Flow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Multi-Center, Placebo-Controlled, Single-Blind, Randomized Clinical Trial

Urokinase Plasminogen Activator: A Potential Thrombolytic Agent for Ischaemic Stroke

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