Evaluation of Optimum Streptokinase Dosage in Systemic Thrombolytic Therapy for Acute Myocardial Infarction: A Randomized Trial

Abstract

The aim of this ongoing study is to determine whether or not there is a difference in terms of efficacy between lower dose and higher dose streptokinase (STK) regimens used in the systemic thrombolytic therapy of acute myocardial infarction. Acute infarction patients are randomized to low dose (600,000 I.U.) or high dose (1,500,000 I.U.) STK delivered over 30 minutes. To date 52 cases have been serially paired and analysed statistically by the method of sequential analysis. One response taken to be of primary importance as an indirect indicator of clot lysis in assessment of treatment is the time to onset of recession of the ST segment towards the isoelectric baseline on the ECG.Another response is the ratio of fibrinogen/fibrin degradation products formed per unit of plasma fibrinogen. This is a direct measurement of plasmin activity. Treatment preference per low dose/high dose pairing is plotted in Figures 1 and 2 respectively for each response. No chart entry is made where there is no marked preference. In both instances, though statistical significance (p < 0.05) has not yet been reached, the trend is strongly in favour of low dose STK or, at a minimum, no difference between the doses. Not least, this has economic implications also.

Efficacy of a New Accelerated Streptokinase Regime in Acute Myocardial Infarction: A Double Blind Randomized Clinical Trial

“…However, noninvasive tests such as CPK peaking have a very limited, if any, predictive value for angiographically proven recanalization [33]. The same criticisms hold true for two other studies [34,35]. The first double blind randomized trial to establish the optimal dose of SK was carried out by Six et al [22] Patients who had symptoms of AMI for less than 4 h were randomized to four groups and were treated with SK intravenously at doses of 0.20, 0.75, 1.5, or 3 MU/60 min.…”