Sixty-Minute Alteplase Protocol: A New Accelerated Recombinant Tissue-Type Plasminogen Activator Regimen for Thrombolysis in Acute Myocardial Infarction

Abstract

The 60-min alteplase thrombolysis in AMI protocol achieved a TIMI grade 3 patency rate of 81.1% at 90 min with no indication of an increased bleeding hazard; it was associated with a 1.2% overall mortality rate. These results are substantially better than those reported from all currently utilized regimens. Head to head comparison with established thrombolytic regimens in a large-scale randomized trial is warranted.

Fibrinolysis for Acute Myocardial Infarction

“…27 Mortality and intracranial hemorrhage tended to be higher with the double-bolus approach, leading investigators to conclude that this modification could not be recommended for general use. Gulba et al 28 have recently demonstrated that a 60-minute rt-PA infusion in an open-labeled, nonrandomized study yielded an 81% TIMI 3 patency at 90 minutes. Further study of this regimen has not been undertaken.…”

Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE Study

“…However, its beneficial effect is limited to only about half the patients exposed to thrombolytic agents. The success rate, defined as TIMI-3 flow (TIMI=thrombolysis in myocardial infarction) at 90 min after the start of treatment, varies between 32% [2] and 80% [3] . Furthermore, thrombolysis exposes the patient to the risk of bleeding: 0·5-1% risk of intracranial haemorrhage and 3-6% risk of other major bleeding complications.…”

Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin

“…Pharmacological regimen: After providing informed consent, patients in FT group assigned to weight-adjusted intravenous UH received a bolus of 60 U/Kg [15] (maximum 4,000 U) and then a bolus of 15 mg ([65 years) or 20 mg (\65 years) of alteplase followed by 75 or 80 mg over 1-h infusion [16,17] by peripheral vein. After FT a constant heparin infusion (12 U/Kg per hour, maximum 1,000 U/h) adjusted to maintain an activated partial thromboplastin time of 50-70 s for 24-48 h was started.…”

“…The main advantage of current FT regimens is to achieve a rapid ''pharmacological embolectomy'' to improve right ventricle dysfunction and consequently the cardiopulmonary and systemic hemodynamic. Considering our previous experiences with 1-h streptokinase regimen [4,6] that has been used in STelevation myocardial infarction successfully, we decided to assess the efficacy and safety profile of 1-h alteplase infusion [16,17], based on the following advantages: (a) the highest TIMI-3 flow in ST-elevation myocardial infarction (81%) [16] in the history of pharmacological reperfusion, (b) in México it was an effective and safe option [17] and (c) low incidence of bleeding complications [16,17]. In addition, 1-h alteplase regimen known as the ''Jerjes PE lysis regimen'' was decided by consensus considering previous results with streptokinase regimen in 1-h [4,6], the pharmacologic alteplase advantages [16] and the strong experience obtained with this regimen in STelevation myocardial infarction in Mexico [17,23].…”

“…Considering our previous experiences with 1-h streptokinase regimen [4,6] that has been used in STelevation myocardial infarction successfully, we decided to assess the efficacy and safety profile of 1-h alteplase infusion [16,17], based on the following advantages: (a) the highest TIMI-3 flow in ST-elevation myocardial infarction (81%) [16] in the history of pharmacological reperfusion, (b) in México it was an effective and safe option [17] and (c) low incidence of bleeding complications [16,17]. In addition, 1-h alteplase regimen known as the ''Jerjes PE lysis regimen'' was decided by consensus considering previous results with streptokinase regimen in 1-h [4,6], the pharmacologic alteplase advantages [16] and the strong experience obtained with this regimen in STelevation myocardial infarction in Mexico [17,23]. Our data suggest that one-hour alteplase infusion plus UH 1 Kaplan-Meier survival curve identifies an improvement of in-hospital and 6-month follow-up outcome in patients who received fibrinolytic therapy and enoxaparin compared to patients with the same risk who received unfractionated heparin alone establishes rapid reversal of pulmonary arterial hypertension and right ventricular heart failure without increasing hemorrhagic complications improving the outcome in high-risk PE.…”