Streptokinase in acute myocardial infarction: a controlled multicentre study in the United Kingdom.

Aber, Clive P.; Bass, N. M.; Berry, C. L.; Carson, P; Dobbs, R. J.; Fox, Kim; Hamblin, Joelle; Haydu, S P; Howitt, G.; MacIver, J. E.; Portal, R W; Raftery, E. B.; Rousell, Ralph H.; Stock, J. P. P.

doi:10.1136/bmj.2.6044.1100

Cited by 85 publications

(14 citation statements)

References 7 publications

(1 reference statement)

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“…22 Similarly, in a randomized study comparing extended infusion of streptokinase (2500 X 10 3 IU over 24 hr) with conventional therapy in 595 patients with symptoms of myocardial ischemia of less than 24 hours duration, Aber et al reported 5 thromboembolic CNS events in each group. 23 In the absence of statistical analysis it appears that thromboembolic or other cerebrovascular events are no more frequent in the groups of unselected patients receiving thrombolytic agents systemically, than in those receiving anticoagulation or conventional therapy for acute MI.…”

Section: Acute Myocardia] Infarctionmentioning

confidence: 99%

Thrombolytic therapy in stroke: possibilities and hazards.

Zoppo¹,

Zeumer²,

Harker³

1986

Stroke

202

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patients with various thrombolytic agents, and to weigh the relative risk of intracerebral hemorrhage in patients treated with fibrinolytic agents for stroke and for other thrombotic disorders. Mechanism of ThrombolysisArterial thrombosis and thrombus extension involve to varying degrees the processes of endothelial injury, platelet aggregation and release, and thrombin generation. Thrombin-mediated fibrinogen cleavage results in fibrin formation which is required for thrombus stabilization.80 Thrombin-mediated fibrin formation occurs in direct relation to platelet activation by several mechanisms. Platelets promote activation of the early stages of intrinsic coagulation by a process that involves a factor XI receptor and high molecular weight kininogen.81 Also, factors V and VHI interact with platelet membrane phospholipids to facilitate the activation of factor X to Xa and the conversion of prothrombin to thrombin.82 Platelet-bound thrombinmodified factor V (factor Va) serves as a high affinity platelet receptor for factor Xa. 83 Consequently, the rate of thrombin generation is accelerated 10 3 fold, providing a potent positive feedback mechanism for initiation of thrombin formation on the platelet surface, fibrin network formation in the thrombus, and indirectly, fibrinolysis.Thrombus dissolution is, in large part, mediated by fibrinolysis localized within the thrombus.84 " 86 Fibrin (and fibrinogen) degradation is catalyzed by plasmin, the product of plasminogen activation. 87 In the consolidating thrombus plasminogen binds to fibrin and to platelets, allowing local release of plasmin within the thrombus. The circulating plasminogen activators, tissue plasminogen activator (tPA) and single chain urokinase plasminogen activator (scuPA), catalyze plasby guest on

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Section: Acute Myocardia] Infarctionmentioning

confidence: 99%

Thrombolytic therapy in stroke: possibilities and hazards.

Zoppo¹,

Zeumer²,

Harker³

1986

Stroke

202

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“…They reported an absolute decrease in mortality of 7.6% in streptokinase-treated patients compared with the control group. During the 1970s, many small, underpowered and nonrandomized trials were performed, which showed mixed results [16][17][18]. Two important clinical trials led to the eventual acceptance of IV thrombolysis for acute myocardial infarction:1) the European Cooperative Study Group for Streptokinase Treatment in Acute Myocardial Infarction [19] and 2) the Gruppo Italiano per la Sperimentazione della Streptochinasi nell'Infarto Miocardico (GISSI) trial [20].…”

Section: Thrombolytics For Acute Myocardial Infarctionmentioning

confidence: 99%

Intravenous Thrombolytics for Ischemic Stroke

Barreto

2011

Neurotherapeutics

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“…Left ventricular thrombus is a common (42-48%) postmortem finding in patients with acute myocardial infarction [13,14]. However, clinical evidence from em bolization for left ventricular thrombus is much less common.…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

“…However, clinical evidence from em bolization for left ventricular thrombus is much less common. An embolic stroke complicates myocardial in farction in less than 6% of patients after an acute myocar dial infarction [13][14][15][16]. Left ventricular thrombi appear to develop on an average of 4-5 days after the myocardial infarction [17,18].…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

Cardiac Evaluation of the Patient with Stroke

Vandenberg¹,

Biller²

1991

Cerebrovasc Dis

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Of the 400,000 new strokes in the United States each year, approximately 85% are due to cerebral infarction, and about 15% of these are from cardiogenic embolization. Emboli from cardiac sources often cause a severe neurological deficit or death. The frequency of these devastating events would likely be reduced if the offending cardiac lesions were adequately recognized and treated. Recently, noninvasive cardiac imaging has expanded our ability to obtain morphological, functional, and metabolic information of the heart and thus diagnose and assess a variety of cardiac conditions, many of which have been implicated as potential causes of cerebral embolization or hypoperfusion. These imaging techniques differ widely in the information they offer, and their use should be optimized in the pursuit of associated cardiac disease in patients with acute focal cerebral ischemia. We believe the use of two-dimensional echocardiography in older patients with focal cerebral ischemia should be limited to those with clinical clues of heart disease. Two-dimensional echocardiography should be considered in all patients younger than 45 years old with otherwise unexplained focal cerebral ischemia. Transesophageal and contrast echocardiography should be used in selected individuals, particularly when the transthoracic images are technically inadequate for the evaluation of mitral and aortic prosthetic valves or vegetations, or whenever there is need for better visualization of the left atrial appendage or interatrial septum, or when a right-to-left shunt is suspected.

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Streptokinase in acute myocardial infarction: a controlled multicentre study in the United Kingdom.

Cited by 85 publications

References 7 publications

Thrombolytic therapy in stroke: possibilities and hazards.

Thrombolytic therapy in stroke: possibilities and hazards.

Intravenous Thrombolytics for Ischemic Stroke

Cardiac Evaluation of the Patient with Stroke

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