TIMI grade 3 flow and reocclusion after intravenous thrombolytic therapy: A pooled analysis

Barbagelata, N.Alejandro; Granger, Christopher B.; Oqueli, Ernesto; Suárez, Luis D.; Borruel, Miguel; Topol, Eric J.; Califf, Robert M.

doi:10.1016/s0002-8703(97)70220-5

Cited by 32 publications

(16 citation statements)

References 50 publications

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“…13 Despite the development of a series of new fibrinolytic agents 14 -16 for the treatment of STEMI, there has been little improvement in survival rate over the past decade, which is perhaps partly related to limited improvement in coronary perfusion, continued occurrence of reinfarction, and bleeding complications. 17,18 The new single-bolus fibrinolytic drug tenecteplase has facilitated the treatment of acute myocardial infarction, with efficacy equivalent to alteplase for 30-day and 1-year mortality and with the added benefit of less systemic bleeding. 16 Because of its simplicity, the bolus regimen is an attractive choice for the prehospital setting.…”

mentioning

confidence: 99%

Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the assessment of the safety and efficacy of a new thrombolytic regimen (ASSENT) 3 plus randomized trial in acute myocardial infarction

Wallentin¹,

Goldstein²,

Armstrong³

2003

ACC Current Journal Review

112

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Background-The combination of a single-bolus fibrinolytic and a low-molecular-weight heparin may facilitate prehospital reperfusion and further improve clinical outcome in patients with ST-elevation myocardial infarction. Methods and Results-In the prehospital setting, 1639 patients with ST-elevation myocardial infarction were randomly assigned to treatment with tenecteplase and either (1) intravenous bolus of 30 mg enoxaparin (ENOX) followed by 1 mg/kg subcutaneously BID for a maximum of 7 days or (2) weight-adjusted unfractionated heparin (UFH) for 48 hours. The median treatment delay was 115 minutes after symptom onset (53% within 2 hours). ENOX tended to reduce the composite of 30-day mortality or in-hospital reinfarction, or in-hospital refractory ischemia to 14.2% versus 17.4% for UFH (Pϭ0.080), although there was no difference for this composite end point plus in-hospital intracranial hemorrhage or major bleeding (18.3% versus 20.3%, Pϭ0.30). Correspondingly, there were reductions in in-hospital reinfarction (3.5% versus 5.8%, Pϭ0.028) and refractory ischemia (4.4% versus 6.5%, Pϭ0.067) but increases in total stroke (2.9% versus 1.3%, Pϭ0.026) and intracranial hemorrhage (2.20% versus 0.97%, Pϭ0.047). The increase in intracranial hemorrhage was seen in patients Ͼ75 years of age. Conclusions-Prehospital fibrinolysis allows 53% of patients to receive reperfusion treatment within 2 hours after symptom onset. The combination of tenecteplase with ENOX reduces early ischemic events, but lower doses of ENOX need to be tested in elderly patients. At present, therefore, tenecteplase and UFH are recommended as the routine pharmacological reperfusion treatment in the prehospital setting.

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mentioning

confidence: 99%

Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the assessment of the safety and efficacy of a new thrombolytic regimen (ASSENT) 3 plus randomized trial in acute myocardial infarction

Wallentin¹,

Goldstein²,

Armstrong³

2003

ACC Current Journal Review

112

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“…A continuous local prothrombotic state with activated and aggregating platelets is regarded to be one of the main reasons for the fairly poor rate of regaining sufficient antegrade (TIMI 3) flow and the occurrence of recurrent ischemia [22,23]. It has been shown that the addition of an platelet aggregation inhibitor is helpful in reducing mortality and reinfarction rates after thrombolysis [24,25].…”

Section: Discussionmentioning

confidence: 99%

Analysis of vessel wall morphology, blood flow velocity, and the hemostatic system in a patient with a large intracoronary thrombus

Haude

Altmann

Eick

et al. 1998

Cathet. Cardiovasc. Diagn.

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A patient with AMI caused by a large thrombus in the proximal LAD was successfully treated with PTCA and an intracoronary lysis combined with the platelet‐receptor antagonist c7E3. Analysis of cellular hemostasis after 1 and 6 months revealed a sustained platelet activation despite combined anti‐platelet therapy with ASA and ticlopidine. A progredient slow‐flow phenomenon appeared during control angiographies, confirmed by intracoronary Doppler examination. Cathet. Cardiovasc. Diagn. 43:298–305, 1998. © 1998 Wiley‐Liss, Inc.

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“…In contrast to varying early patency with different regimens, patency rates at 3-24 hours and beyond were found to be similar. Reocclusion rates were generally higher after fibrin specific therapy than after nonfibrin agents (13%vs 8%) especially in the absence of optimal concurrent IV heparin (1997) [15]. However reperfusion by thrombolysis is an "illusion" created by the imperfect barometer of the static 90 minute angiographic view of coronary patency.…”

Section: Reperfusionmentioning

confidence: 99%

Looking Beyond Reperfusion

2016

JCCR

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Acute Myocardial Infarction is thrombotic occlusion of coronary artery and sudden stoppage of blood supply leading to death of heart muscles. The Reperfusion phase of the treatment although promising could salvage at best only 2-4% of the myocardium at 6 months and also carries the risk of reperfusion injury. Despite the best optimal reperfusion therapy, the mortality of AMI still remains 9% at one year and cardiac failure occurs in 11.0%. This appeals us to look beyond reperfusion therapy, repairing or regenerating lost myocardium via cell based therapy, tissue engineering and gene therapy. Efforts are directed towards regenerating myocardium which may revolutionize the treatment of AMI. This not only will decrease the mortality but also improve long term survival and quality of life.

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TIMI grade 3 flow and reocclusion after intravenous thrombolytic therapy: A pooled analysis

Cited by 32 publications

References 50 publications

Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the assessment of the safety and efficacy of a new thrombolytic regimen (ASSENT) 3 plus randomized trial in acute myocardial infarction

Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the assessment of the safety and efficacy of a new thrombolytic regimen (ASSENT) 3 plus randomized trial in acute myocardial infarction

Analysis of vessel wall morphology, blood flow velocity, and the hemostatic system in a patient with a large intracoronary thrombus

Looking Beyond Reperfusion

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