“Rescue” thrombolysis with intracoronary tissue plasminogen activator for failed intravenous thrombolysis with streptokinase for acute myocardial infarction

White, Harvey D.; Cross, D.; Williams, Barbara F.; Norris, R. M.; Woo, Kam S.; Hamer, Andrew; Elliott, John; Ormiston, John A.

doi:10.1016/s0002-9149(00)80070-3

Cited by 16 publications

(13 citation statements)

References 18 publications

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“…On the other hand, consistent with other studies [7][8][9][10], tissue plasminogen activator might be an effective treatment. Our data suggest that the failure of repeat thrombolysis by intracoronary streptokinase cannot be attributed to a failure to achieve systemic fibrinogenolysis induced by intravenous streptokinase or intracoronary streptokinase.…”

Section: Discussionsupporting

confidence: 91%

“…Repeated administration of streptokinase or another thrombolytic agent, for example, tissue plasminogen activator, are obvious possible treatments. Earlier noncomparative studies reported the positive effect of readministration of a thrombolytic agent after failed intravenous streptokinase reperfusion therapy [7,8], or in suspected reinfarction following thrombolytic therapy with streptokinase, tissue plasminogen activator, or their combination [9,10]. The purpose of this report is to show our initial experience in comparing streptokinase and tissue plasminogen activator for repeat thrombolysis in patients During the last decade early reperfusion therapy has become the cornerstone of the treatment of acute with failed reperfusion therapy following intravenous streptokinase.…”

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confidence: 99%

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An angiographic study of intracoronary streptokinase versus intravenous tissue plasminogen activator after failed coronary thrombolysis with intravenous streptokinase

et al. 1996

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Objective: The medical treatment of failed intravenous streptokinase in patients with acute transmural myocardial infarction using angiographic endpoints. Design: Prospective open angiographic comparison of intracoronary streptokinase with intravenous tissue plasminogen activator. Setting: Single center study in a tertiary institution. Subjects: Eighty-five patients with acute myocardial infarction within 4 hours after symptom onset. Treatment regimens: The subjects received 1.5 million U intravenous streptokinase. Coronary angiography within 48 hours (median 19 hours) showed infarct-related vessel patency in 65 patients (76%). In the catheterization laboratory the 20 patients (24%) with failed intravenous streptokinase received repeat thrombolysis immediately after angiography. The first 10 patients with failed intravenous streptokinase received intracoronary streptokinase at a dose of 4000 U/min in the occluded infarct-related artery for a maximum of 1 hour. The subsequent 10 pati ents received high-dose front-loaded intravenous tissue plasminogen activator (100 mg in 1 hour). Results: In none of the patients receiving repeat streptokinase was reperfusion obtained. In 6 of 10 (60%) of the patients receiving tissue plasminogen activator, reperfusion was seen within 60 minutes (p < 0.005 vs. intracoronary streptokinase). One patient (5%) died and two refused follow-up angiography. Seventeen (88%) patients underwent angiography 3 months later according to the protocol. Two patients showed a persistently reperfused infarct-related artery, three reoccluded, four spontaneously reperfused, and eight had a persistently occluded infarct-related artery. The left ventricular ejection fraction was slightly higher at 3 months, and there were no differences between the patients with open vessels (increase +7.7 +/- 5.8%) and those with persistently occluded vessels (increase +5.8 +/- 6.8%). Conclusions: Repeat thrombolysis after failed intravenous streptokinase ca n be achieved with front-loaded intravenous tissue plasminogen activator but not with intracoronary streptokinase. Although patient numbers are small and repeat thrombolysis was performed rather late, this study leads the way to affordable optimization of thrombolysis, which needs large-scale testing.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

An angiographic study of intracoronary streptokinase versus intravenous tissue plasminogen activator after failed coronary thrombolysis with intravenous streptokinase

et al. 1996

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“…10,11 Given the importance of the platelet component of the thrombus in explaining thrombus resistance to lyses, rescue therapy with glycoprotein Gp IIb/ IIIa receptor blockers in patients in whom thrombolysis has failed may be an attractive strategy. 12 -14 In our study 100 patients of acute Myocardial infarction who met the criteria of failed thrombolysis were randomized (single blind) into 2 groups of fifty patients each i.e.…”

Section: Materials and Methods: One Hundredmentioning

confidence: 99%

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2017

IJPSR

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ABSTRACT:We studied the feasibility, safety, clinical benefit, efficacy and 30 day outcome in 50 patients receiving tirofiban in patients with failed thrombolysis in acute ST elevation myocardial infarction, and compared with 50 patients for age, gender and infarct location, who did not receive rescue treatment for different reasons. Tirofiban resulted in an overall ST segment elevation, resolution, at 240 minutes in 44 patients (88 %). Incidence of major events during hospitalization was higher in control group. One patient (2 %) died in study group against 4(8%) in control group while 4 patients had refractory angina needing early percutaneous coronary intervention as compared to 13 in control group. None reinfarcted as against 4 in control group. Two patients developed congestive heart failure against 8 in control group. However, minor bleeding events (mainly gum) were significantly higher, 9 against 0 in control group. Coronary angiography revealed residual thrombus only in 4 patients treated with tirofiban compared to 13 in controls and surprisingly the number of stents required were less in study group (74 % i.e. 37 patients) against (96 % i.e. 48 patients) in control group. On 30 day follow up no death, congestive heart failure or repeat revascularization procedure was recorded in the study group with significant improvement in left ventricular ejection fraction, while as there were 3 deaths and 4 patients had congestive heart failure in control group INTRODUCTION: Success rate of intravenous thrombolysis is close to 70 %. Therefore stratigies for failed thrombolysis or reocclusion/ reinfarction also need to be planned in advance. Ongoing chest pain, non-resolution of ECG i.e. failure of the elevated ST segment to fall by 50% or more in lead with maximal ST elevation recorded 90 minutes after onset of thrombolysis, hemodynamic or electric instability indicate failure of recanalization. Repeat thrombolysis with the same or other agent is not to be practiced.

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“…PTCA has recently shown to be beneficial regarding left ventricular function [14], but no beneficial effect concerning survival has yet been proven [15, 16]. Although prevalent in daily clinical practice, repeated thrombolytic therapy with rt-PA after unsuccessful SK therapy has only been evaluated in a few and small randomized studies [17, 18, 19]. These studies demonstrated beneficial effect on TIMI flow [17]or on left ventricular function [19].…”

Section: Introductionmentioning

confidence: 99%

“…Although prevalent in daily clinical practice, repeated thrombolytic therapy with rt-PA after unsuccessful SK therapy has only been evaluated in a few and small randomized studies [17, 18, 19]. These studies demonstrated beneficial effect on TIMI flow [17]or on left ventricular function [19]. …”

Section: Introductionmentioning

confidence: 99%

Early Reperfusion Assessment and Repeated Thrombolysis in Acute Myocardial Infarction Estimated by Repeated Standard Electrocardiography

et al. 2000

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Thrombolytic therapy with streptokinase (SK) in acute myocardial infarction (AMI) does not result in early reperfusion in approximately 25% of patients. We hypothesized that early repeated thrombolysis with rt-PA in patients with early failed reperfusion would result in myocardial reperfusion. Fifty-nine AMI patients with a symptom delay of <6 h, treated with SK were included. ECG was taken on admission and after 90 and 180 min. An ST recovery of ≥25% at 90 min was interpreted as successful reperfusion. Sixteen patients had failed reperfusion at 90 min and were randomized to repeated thrombolysis with rt-PA or placebo. At 180 min from SK start, ST recovery was higher in the placebo group than in the rt-PA group (71 vs. 40%, p = 0.05). No serious bleeding complications were observed. Due to the limited sample size it was not possible to draw prominent conclusions.

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“Rescue” thrombolysis with intracoronary tissue plasminogen activator for failed intravenous thrombolysis with streptokinase for acute myocardial infarction

Cited by 16 publications

References 18 publications

An angiographic study of intracoronary streptokinase versus intravenous tissue plasminogen activator after failed coronary thrombolysis with intravenous streptokinase

An angiographic study of intracoronary streptokinase versus intravenous tissue plasminogen activator after failed coronary thrombolysis with intravenous streptokinase

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Early Reperfusion Assessment and Repeated Thrombolysis in Acute Myocardial Infarction Estimated by Repeated Standard Electrocardiography

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