Fibrinolytic Treatment of Coronary Thrombosis

Dewar, H. A.; Horler, A. R.; Cassells-Smith, A. J.

doi:10.1136/bmj.2.5253.671

Cited by 15 publications

(4 citation statements)

References 16 publications

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“…Thrombolytic therapy has been tried by many investigators in acute myocardial infarction; however, systemic application was used in most studies (1,5,7,17,20,21) and the results were not controlled by coronary angiography. Some investigators discuss a beneficial effect of systemic streptokinase therapy by alteration of the rheological properties of the blood (6) and by lysis of microthrombi in the border zone of infarction since recanalization of the infarct vessel by systemic thrombolysis (22) probably occurs too slowly to salvage jeopardized myocardium (3).…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators discuss a beneficial effect of systemic streptokinase therapy by alteration of the rheological properties of the blood (6) and by lysis of microthrombi in the border zone of infarction since recanalization of the infarct vessel by systemic thrombolysis (22) probably occurs too slowly to salvage jeopardized myocardium (3). Studies evaluating the effects of systemic fibrinolysis upon mortality and clinical course report conflicting results (1, 5,7,17,20,21). AIl investigators found a significant incidence of hemorrhagic complications.…”

Section: Discussionmentioning

confidence: 99%

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Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase

Rentrop

Blanke

Karsch

et al. 1979

Clinical Cardiology

395

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Summary: In five patients with acute myocardial infarction. the effects of both intracoronary nitroglycerin (NTG) and subsequent intracoronary streptokinase application were evaluated. In addition. transluminal recanalization was performed in one of these patients. Injection of NTG into the infarct-related coronary artery resulted in improved distal filling of the subtotally occluded left circumflex artery in one patient, and in transient patency of the completely occluded right coronary artery in a second patient. In a third patient patency of the totally occluded left anterior descending artery (LAD) was achieved by transluminal recanalization with a guide wire. In a fourth patient with occlusion of the LAD. there was no response to intracoronary NTG and mechanical recanalization was not attempted. Subsequent intracoronary infusion of streptokinase (1.000-2.000 U /min for 15-60 min) resulted in a further and long-term reduction of narrowing at the site of acute occlusion in patients I-III and in opening of the completely occluded LAD in patient IV. Improvement of lumen was paralleled by alleviation of symptoms. In a fifth patient. in whom the LAD was subtotally occluded. the degree of coronary obstruction could not be changed by intracoronary application of NTG or by lysis. In this patient. symptoms and ECG changes improved with reduction of pathologically elevated blood pressure values. The findings suggest that myocardial infarction had been caused by thrombotic occlusion in four patients. and that spasm of the infarct vessel could have been an additional factor in two of these patients. In the fifth patient. an increase of afterload in the presence of a subtotal lesion might have caused the critical imbalance between oxygen supply and demand. resulting in cell death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase

Rentrop

Blanke

Karsch

et al. 1979

Clinical Cardiology

395

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“…At that time it was demonstrated that patients with recent myocardial infarction were tolerant of an intensive thrombolytic state induced by streptokinase (Fletcher et al, 1959). Several small or uncontrolled studies on the use of plasmin, streptokinase (SK) or urokinase (UK) in the treatment of recent myocardial infarction were subsequentiy reported (De Leon et al, 1960;Dewar et al, 1961Dewar et al, , 1963Richter et al, 1962;Datey et al, 1962;Lippschutz et al, 1965;Sailer, 1968;Poliwoda et al, 1963;Schrnutzler, 1963;Haan et al, 1965).…”

Section: Introductionmentioning

confidence: 99%

Streptokinase in Acute Myocardial Infarction Extended Report of the European Cooperative Trial

1981

Journal of Internal Medicine

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“…Early clinical trials conducted during the 1950s, 1960s and 1970s included small num bers of patients and varied widely in their design [63][64][65][66][67][68][69]: therefore, their results were frequently inconclusive. However, when considered collectively, a significant reduc tion in patient mortality following thrombo lytic therapy became evident [70].…”

Section: Patient Mortalitymentioning

confidence: 99%

Seminars in Thrombosis, Thrombolysis and Vascular Biology

1991

Cardiology

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In general terms, thrombotic disorders of the cardiovascular system are characterized by poorly regulated, nonphysiologic thrombus formation. Considered more specifically, however, pathologic thrombosis represents a critical imbalance, frequently at both the systemic and vascular levels, of coagulation, anticoagulation and fibrinolysis. Indeed, the balance is shifted toward coagulation, preventing normal physiologic blood flow. Anticoagulants have been a mainstay in the treatment of thrombotic disorders. However, emerging strategies have focused primarily on thrombus dissolution (fibrinolysis), which can be efficiently achieved with the administration of extrinsic plasminogen activators. Clearly, thrombolytic therapy is currently the most direct means of restoring blood flow, vital organ perfusion and hemostatic balance among patients with thrombotic disorders of the cardiovascular system.

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Fibrinolytic Treatment of Coronary Thrombosis

Cited by 15 publications

References 16 publications

Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase

Acute myocardial infarction: Intracoronary application of nitroglycerin and streptokinase

Streptokinase in Acute Myocardial Infarction Extended Report of the European Cooperative Trial

Seminars in Thrombosis, Thrombolysis and Vascular Biology

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