Efficacy and Safety of a New Streptokinase Regimen with Enoxaparin in Acute Myocardial Infarction

Tatu-Chiţoiu, Gabriel; Teodorescu, Cristina; Dan, Monica; Căpraru, P; M, Guran; Istrătescu, Oana; Tatu-Chitoiu, Alexandrina; Bumbu, Aurelia; Dorobanțu, Maria

doi:10.1023/b:thro.0000011372.26594.01

Cited by 8 publications

(9 citation statements)

References 37 publications

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“…For patients with STEMI to be treated with fibrinolysis, 17 studies supported enoxaparin over UFH (LOE1 336,[387][388][389][390][391][392][393] ; LOE 2 341,394,395,396 ; LOE 4 397 ; LOE 5 393,396,398 -401 ) Twelve other studies were neutral comparing enoxaparin and UFH. [402][403][404][405][406][407][408][409][410][411] Reviparin. One study demonstrated improved clinical outcome with reviparin compared with UFH in STEMI patients treated with fibrinolysis (LOE 1).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

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“…After review of abstracts, an additional 16 studies were excluded. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] After review of the full article, an additional 8 studies were excluded because they were not properly randomized (nϭ3) [33][34][35] ; because at least 1 randomized treatment group did not receive aspirin (nϭ3) 36 -38 ; or because they were preliminary reports or the results of a substudy with the main results having been reported elsewhere (nϭ2). 39,40 Clinical outcome data could not be obtained for 1 additional study, 41 leaving 14 randomized trials, involving a combined total of 25 280 patients, for inclusion in the meta-analysis (Tables 1 to 3).…”

Section: Study Selectionmentioning

confidence: 99%

Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction

et al. 2005

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“…5 For understandable reasons related to the potential risk of hypotension (a well known specific effect of SK) and hemorrhagic complications, standard SK regimen (1.5 million units over 60 minutes) remained unchanged during last 15 years. 4 …”

Section: Discussionmentioning

confidence: 99%

“…However, some evidence points to the fact that a minimum dose of 500 U/kg/min may be needed for effective tissue level reperfusion, a dose that can not be obtained with such a relatively slow infusion over 60 minutes. 4 …”

Section: Introductionmentioning

confidence: 99%

Fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Accelerated versus standard Streptokinase infusion regimen

Bendary

Tawfik

Mahrous

et al. 2017

J Cardiovasc Thorac Res

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Introduction: Timely fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and hence preserves LV function and reduces mortality. Optimal regimen of streptokinase (SK) infusion in such patients is a matter of interest. The current study aimed to compare efficacy and safety of accelerated SK infusion regimen in patients with STEMI versus the standard one. Methods: One hundred consecutive STEMI patients were randomly allocated into one of 2 groups: group I (50 patients) who received accelerated SK regimen (1.5 million units over 30 minutes) and group II (50 patients) received standard SK regimen (1.5 million units over 60 minutes). Efficacy was evaluated non-invasively using clinical (chest pain), ECG (resolution of ST segment) and laboratory tests (earlier and higher peaking of cardiac troponin I). Safety was evaluated by assessment of multiple in-hospital adverse events. Results: Both groups were statistically matched in all baseline criteria. There was a significant difference between both groups regarding each parameter of successful reperfusion in favor of accelerated regimen. When all these parameters were combined, 31 patients (62%) had successful reperfusion in group I versus 19 patients (38%) in group II (P = 0.016). We did not report any significant difference between both groups regarding in-hospital mortality, in-hospital heart failure, major bleeding, hypotension or allergic reaction to SK. Mean pre-discharge ejection fraction was higher in group I than group II (50.9 ± 6.6% versus 47.3 ± 4.6%, P = 0.002). Conclusion: Accelerated regimen of SK infusion is safe and effective method of reperfusion in patients with STEMI.

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Efficacy and Safety of a New Streptokinase Regimen with Enoxaparin in Acute Myocardial Infarction

Cited by 8 publications

References 37 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction

Fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Accelerated versus standard Streptokinase infusion regimen

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