Role of thrombolysis in reperfusion therapy for management of AMI: Indian scenario

Dalal, Jamshed; Sahoo, Prasanta Kumar; Singh, Rakesh Kumar; Dhall, Anil; Kapoor, Rajneesh; Krishnamurthy, A.; Shetty, Sadanand; Trivedi, Shailendra; Kahali, Dhiman; Shah, Bhupesh; Chockalingam, K.; Abdullakutty, Jabir; Shetty, Pradeep K; Ray, Raja; Desai, Devang; Pachiyappan,; Ratnaparkhi, G; Sharma, Megha; Sambasivam, K.A.

doi:10.1016/j.ihj.2013.08.032

Cited by 17 publications

(24 citation statements)

References 53 publications

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“…However, a disadvantage of this agent is that it must be administered over 24 hours . Streptokinase is also associated with antibody development due to its nonspecific plasminogen binding, provoking allergic reactions and hypotension . These antibodies can be transferred to the fetus, although this would only be clinically concerning if the fetus needed subsequent treatment with a thrombolytic…”

Section: Thrombolytic Agentsmentioning

confidence: 99%

“…Reteplase is cleared both renally and hepatically . Reteplase also has a longer half‐life, allowing for bolus administration in the treatment of acute MI . However, reteplase is not currently FDA approved for treatment of PE, making dosing unclear in this population…”

Section: Thrombolytic Agentsmentioning

confidence: 99%

“…Lastly, tenecteplase is a newer third‐generation thrombolytic agent derived through modifications of tissue plasminogen activator at three sites . Advantages of tenecteplase include its greater potency, increased fibrin specificity, and longer duration due to decreased clearance from plasma.…”

Section: Thrombolytic Agentsmentioning

confidence: 99%

“…According to the tenecteplase package insert, multiple intravenous administrations resulted in toxicity to both the mother and embryo in the rabbit model without evidence of toxicity following a single intravenous administration . Similar to reteplase, tenecteplase is administered as a single bolus dose in patients with acute MI . However, because tenecteplase does not have FDA approval for the treatment of PE, dosing for this indication remains unclear…”

Section: Thrombolytic Agentsmentioning

confidence: 99%

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Thrombolysis for Massive Pulmonary Embolism in Pregnancy

et al. 2017

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Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series. We reviewed all reports of thrombolytics, systemic or catheter directed, used in pregnant patients with massive PE. This article summarizes the risks for thromboembolism in pregnancy, compares and contrasts thrombolytic agents in this setting, and provides a recommendation for management of massive PE in this special population. Overall, reports suggest that the use of these agents is associated with beneficial outcomes and a relatively low risk of complications. The quality of this evidence is low, and clinical judgment is required to assess individual patients for risks versus benefits of thrombolysis.

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Section: Thrombolytic Agentsmentioning

confidence: 99%

Section: Thrombolytic Agentsmentioning

confidence: 99%

Section: Thrombolytic Agentsmentioning

confidence: 99%

Section: Thrombolytic Agentsmentioning

confidence: 99%

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Thrombolysis for Massive Pulmonary Embolism in Pregnancy

et al. 2017

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“…52% of CVD in India occur below the age of 50 years and about 25% of acute myocardial infarction (AMI) in India occur below the age of 40 years. Disabilityadjusted life years lost due to CAD per 1000 populations in India are three times higher than in developed countries, thus having sustainable implication on Indian growing workforce [1][2][3][4]. Rates of primary percutaneous coronary intervention (PCI) were lower while that of thrombolytic treatment was higher than in developed countries.…”

Section: Introductionmentioning

confidence: 99%

Can Cost of Pharmacological Thrombolytic Therapy Be a Medication Management Strategy for Acute Coronary Syndrome?

Kumar

Panda

2017

Asian J Pharm Clin Res

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Objectives: In Indian health-care system with delayed access to a minimum number of catheter laboratories and rarity of insurance benefits, prehospital and in-hospital thrombolytic has become the choice for patients with acute coronary syndrome (ACS), where many patients bear the economic burden of pharmacological thrombolytic. The present study was carried out to evaluate the pattern of prescribing of pharmacological thrombolytic agents in hospitalized ACS patients and associated cost burden. Methods:A prospective observational cohort study of prescription was conducted for in-patient admitted to intensive care unit for thrombolytic and antithrombotic drug utilization pattern. The direct cost analysis was performed from patient's perspective where a direct cost was calculated using pharmacy bills. All other cost was assumed to be same. Results:Data of 288 patients were collected from which 108 (37.5%) patients were ST-elevation myocardial infarction (STEMI) and 180 (62.5%) patients were non-STEMI. The mean number of drugs prescribed was 11±2 which constitutes a mean of 3.1±0.7 reperfusion drugs. 59% of patients were prescribed with enoxaparin (0.6 ml/seconds route) for the mean duration of 4 days. The average prescription cost for ACS admission was around Rs.7159.5±5137.2 (Rs.1101-Rs.22202). The average cost of pharmacological thrombolytic therapy was Rs.4557±3468.3 (Rs. 23-Rs.12542). The mean cost of pharmacological thrombolytic therapy was found to be 63% of the total direct cost of drugs borne by the patient. The cost of therapy was positively correlated with duration of stay (p=0.000) and insignificantly correlated with a number of drugs. Conclusion:Antiplatelets were the most preferred followed by anticoagulants. The mean number of drugs per encounter was high but was rational as per standard guidelines. The mean cost for pharmacological reperfusion therapy was found to be more than half of mean prescription cost for the management of ACS.

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