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Gore J M - - 1993
The proportion of patients with acute myocardial infarction who are currently being treated with thrombolytic therapy is small. It is not readily apparent why the use of thrombolytic therapy is not more widespread. Several factors have been raised to explain the limited use of thrombolytic therapy, including patient age and ...
Becker R C - - 1993
Platelets, long recognized for their role in physiological (protective) hemostasis, have been shown conclusively to play an intricate role in both coronary arterial atherogenesis and acute thrombosis. Accordingly, antiplatelet agents have emerged as a prominent feature in treatment strategies designed to prevent and directly confront the progression and thrombotic complications ...
Van de Werf F - - 1993
The immediate direct aim of thrombolytic therapy is rapid recanalization of the infarct-related coronary artery. Coronary patency rates observed in the different placebo-controlled and direct comparative trials of thrombolytic agents at different times after the onset of treatment are summarized. It is concluded that 1) for early reperfusion rt-PA is ...
Boysen G - - 1993
In the period from October 1990 to December 1991, 23 patients with acute ischemic stroke were treated with recombinant tissue plasminogen activator (rt-PA) at a median of 205 min (range 78-355 min) after symptom onset. In this open pilot study rt-PA was given intravenously after an acute CT scan had ...
Talalak P - - 1993
Hemostatic profiles and cardiac enzymes were studied in 55 acute myocardial infarct (AMI) patients to assess SK and rt-PA therapy. Hypofibrinogenemia occurred 85% in SK group and 55% in rt-PA group with high FDP and D-Dimer, indicating systemic fibrinogenolysis and local crosslinked fibrin clot lysis. The incidence of bleeding in ...
Jansson J H - - 1993
Disturbances of the fibrinolytic system have been associated with cardiovascular disease and its risk factors. In the present study the effects of an ACE-inhibitor (enalapril) and a placebo on the fibrinolytic system have been compared. Eighty one survivors of acute myocardial infarction were randomised to treatment with enalapril or placebo. ...
Thomas S H - - 1993
The use of thrombolytic agents for both coronary and noncoronary indications is a rapidly progressing field. There has been substantial debate over which disease processes ultimately benefit from the use of thrombolytic agents. In addition, many recent studies have focused on comparing different thrombolytic agents and dosing regimens in an ...
Lijnen H R - - 1993
Despite their widespread use in patients with acute myocardial infarction, all currently available thrombolytic agents suffer from a number of significant limitations, including resistance to reperfusion, the occurrence of acute coronary reocclusion and bleeding complications. Furthermore, the therapeutic use of plasminogen activators as thrombolytic agents requires intravenous infusion of relatively ...
Ross A M - - 1993
Despite impressive clinical advantages proven for reperfusion (thrombolytic) therapy in acute myocardial infarction, considerable controversy persists regarding patient selection, choice of fibrinolytics, adjunctive therapies, and the role of angioplasty. Accruing new information supports the understanding that only very early reperfusion substantially salvages jeopardized myocardium, but that by other mechanisms some ...
Grines C L - - 1992
The relative efficacy and safety of individual thrombolytic agents, administered alone and with antiplatelet and antithrombotic drugs, in the treatment of acute myocardial infarction are presented. The clinical benefits and risks of treatment choices are discussed in relation to the mechanisms of the formation and prevention of thrombus and thrombolysis. ...
Andreotti F - - 1992
Plasma von Willebrand factor, plasminogen activator inhibitor activity and C-reactive protein were assessed as markers of coronary recanalisation in 30 patients with acute myocardial infarction receiving tissue-type plasminogen activator (t-PA). Blood samples were taken before t-PA (time 0), 4-hourly for 24 h and daily up to 72 h. A continuous ...
Doorey A J - - 1992
OBJECTIVE: To assess the use of thrombolytic therapy for acute myocardial infarction, evaluating whether inclusion and exclusion criteria should be altered as well as the public health implications of any such alterations. DATA SOURCES: Data obtained were from English-language articles on the use of thrombolytic therapy in acute myocardial infarction. ...
Ruocco N A NA - - 1992
OBJECTIVES: This study was designed to assess the possibility that a subgroup of patients at high risk for recurrent ischemia and reinfarction after thrombolytic therapy might benefit from early intervention. BACKGROUND: The Thrombolysis in Myocardial Infarction Phase II (TIMI II) study recently concluded that an obligatory invasive strategy after thrombolytic ...
Popma J J - - 1992
OBJECTIVES: The goal of this study was to lend insight into the mechanisms responsible for the beneficial effects of combination thrombolytic therapy. BACKGROUND: Combination thrombolytic therapy for acute myocardial infarction has been associated with less reocclusion and fewer in-hospital clinical events than has monotherapy. METHODS: Infarct-related quantitative coronary dimensions and ...
Wallbridge D R - - 1992
Audit is now an important component of the provision of acute cardiology services. In particular, the desire to administer thrombolytic treatment early in acute myocardial infarction has led to a reappraisal of admission procedures. Using records collected prospectively onto a computerized coronary care database for 36 months to December 1991, ...
Woo K S - - 1992
Thrombolytic therapy using recombinant-tissue plasminogen activator, urokinase and streptokinase for acute myocardial infarction was instituted in the coronary care unit of the Prince of Wales Hospital in Hong Kong in 1988. To evaluate its impact on hospital mortality of acute myocardial infarction, the database of 465 patients (mean age 65.2 ...
Mizuno K - - 1992
To clarify the pathogenesis of an impending infarction and to investigate the difference between the pathogenesis of an acute myocardial infarction and an impending infarction, we have performed percutaneous transluminal coronary angioscopy in 13 patients with an impending infarction and in 13 patients with an acute myocardial infarction. As a ...
Grauer K - - 1992
In the setting of acute myocardial infarction, the importance of the 12-lead electrocardiogram has increased tremendously. In addition to facilitating diagnosis of acute ischemic syndromes, including acute myocardial infarction, the 12-lead electrocardiogram may provide invaluable assistance in determining which patients are most suitable for thrombolytic therapy, and it may provide ...
Boström P A - - 1992
This study presents the outcome of myocardial scintigraphy performed before and after thrombolytic treatment in 16 patients with acute myocardial infarction using 99Tcm-Sestamibi (Cardiolite, Du Pont Scandinavia AB, Kista, Sweden). The patients were given 99Tcm-Sestamibi intravenously as soon as possible after the decision to give thrombolytic treatment. When the patients ...
Anderson J L - - 1992
OBJECTIVES: This double-blind, randomized, multicenter trial was designed to compare the effects of treatment with anistreplase (APSAC) and alteplase (rt-PA) on convalescent left ventricular function, morbidity and coronary artery patency at 1 day in patients with acute myocardial infarction. BACKGROUND: Anistreplase (APSAC) is a new, easily administered thrombolytic agent recently ...
More R S - - 1992
Seven cases of intracerebral haemorrhage were identified following the use of thrombolytic therapy in a total of 710 patients with acute myocardial infarction. Each case was reviewed in detail with particular attention to the presenting symptoms. A confusional state was the commonest initial feature. Increased age and male sex were ...
Jishi F - - 1992
A 62 year old woman admitted with a history suggesting acute myocardial infarction had thrombolytic treatment with anisoylated plasminogen-streptokinase activator complex, which resulted in submucosal haemorrhage in the oesophagus; this caused dissection of the wall of the oesophagus and complete dysphagia. The haematoma resolved spontaneously, leaving behind a diverticulum, with ...
- - 1992
OBJECTIVE: To assess the feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners. DESIGN: Randomised double blind parallel group trial of anistreplase 30 units intravenously and placebo given either at home or in hospital. SETTING: 29 rural practices in Grampian admitting patients to teaching hospitals in Aberdeen (average distance ...
Gallagher T J - - 1992
Diving accidents include air embolism and decompression sickness. Both require early stabilization and initiation of therapy before transfer to a definitive medical center for recompression therapy. Initial treatment consists of hydration, oxygen therapy and often steroids and antithrombosis therapy. Symptoms must be separated from other related conditions including myocardial infarction.
Gray D - - 1992
Admissions to hospital of patients aged 75 or over with symptoms suggestive of acute myocardial infarction have increased markedly since 1982. Patients over 75 present to hospital as soon after the onset of symptoms as do younger patients; they require more treatment with diuretics and digoxin than do younger patients ...
Granger C B - - 1992
In the past 10 years, thrombolytics have become standard therapy for acute myocardial infarction. Although the ability of streptokinase to lyse clot was first recognised in the 1930s, thrombolytic therapy was not used to treat acute myocardial infarction until the early 1980s, when the importance of thrombosis in the pathogenesis ...
Jain P - - 1992
Fifty six patients (52 males, 4 females, mean age 53.6 +/- 8 years, range 35-75 years) were studied to determine the influence of clinical variables, site of myocardial infarction, thrombolytic therapy, documented arrhythmias and left ventricular ejection fraction (LVEF) on the incidence of ventricular late potentials (LP's). LP's were detected ...
Lawrie D M - - 1992
The introduction of routine thrombolytic therapy in the Cardiac Care Unit (CCU) of a District General Hospital has resulted in an increased demand for admission particularly in the 70+ age group. Complications and side effects of such treatment have been similar to those reported in several large multicentre trials. The ...
Arnold A Z - - 1992
The benefits of thrombolytic therapy in reducing the mortality associated with acute myocardial infarction are well documented. Presumably, this is on the basis of a patent IRA, although other mechanisms may be involved. Because there is a 25% to 30% failure rate for thrombolytic therapy that is associated with a ...
Woo K S - - 1992
Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue plasminogen activator (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 h after onset, and intravenous heparin or dipyridamole therapy started at 3 h, were studied prospectively. Their mean age was 59.6 +/- ...
Heller R F - - 1992
OBJECTIVE: To describe changes in medications administered to patients with acute myocardial infarction between 1984/1985 and 1988/1990 and changes in case fatality. DESIGN: Descriptive study from the Newcastle MONICA Project, which monitors all heart attacks in men and women aged 25 to 69 years in the Lower Hunter Region of ...
Krumholz H M - - 1992
BACKGROUND: There is a lack of consensus among cardiologists about the potential benefit of thrombolytic therapy for suspected acute myocardial infarction in older patients. To investigate this issue, we constructed a decision-analytic model for patients 75 years of age or older who present with ST-segment elevation within six hours of ...
Becker R C - - 1992
The natural history of patients with acute myocardial infarction treated with thrombolytic therapy includes two distinct phases: the initial or acute phase is characterized pathologically by atheromatous plaque rupture and thrombotic coronary arterial occlusion, and clinically by the abrupt onset of symptoms. Prompt restoration of coronary blood flow and myocardial ...
Selig M B - - 1992
Only a small percentage of patients who have acute myocardial infarction receive the benefit of intravenous thrombolytic therapy, often because logistics result in unnecessary pre-hospital and in-hospital delays. Dr Selig therefore recommends that a streamlined protocol be available and that it be updated at regular intervals to ensure that this ...
Bouten M J - - 1992
The improvement in survival in patients undergoing thrombolytic therapy in myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPerfusion in Acute Infarction Rotterdam (REPAIR) study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, 'Actilyse'). A small portable ECG computer ...
Claessens J - - 1992
While it is no longer possible to imagine the treatment of an acute transmural myocardial infarction without the use of thrombolytic agents, some discussion still exists as to the choice of the thrombolytic agent. Our study concerns a group of 160 patients with an acute transmural myocardial infarction, 60 of ...
Eisenberg J D - - 1992
Tissue plasminogen activator was administered intravenously to a patient with clinical features of, but without electrocardiographic criteria for, an acute myocardial infarction. The ultimate treatment decision was based upon echocardiographic findings diagnostic for an anteroseptal myocardial infarction. Subsequent coronary angiography demonstrated a severe proximal, but patent left anterior descending stenosis. ...
Carney R J - - 1992
Clot dissolution with restoration of infarct-related artery blood flow is the likely mechanism for the improved prognosis and mortality reduction seen after thrombolytic therapy of acute myocardial infarction. A pilot study has suggested that 100 mg of recombinant tissue-type plasminogen activator (rt-PA) infused over 90 min may lead to higher ...
Norris R M - - 1992
We measured levels of tissue plasminogen activator (t-PA) antigen in 100 patients within six hours of the onset of acute myocardial infarction, in 34 patients with chronic angina but no recent infarction, and in 36 normal subjects. We also assayed von Willebrand factor in the acute patients and in the ...
Machraoui A - - 1992
A prospective, open, multicentre post-marketing surveillance on the efficacy and safety of intravenous APSAC in the treatment of acute myocardial infarction was performed in 2436 patients. Reperfusion suggested by non-invasive parameters was achieved in 77.3% of patients. In-hospital mortality was low (7.1%). After exclusion from analysis of patients greater than ...
Cranswick R - - 1992
Regional wall motion was examined by angiography after 3 weeks in 154 patients taking part in the Thrombolysis in Coronary Occlusion (TICO) Trial. Coronary patency rate was greater after administration of recombinant tissue plasminogen activator, (rt-PA 62/77pts 81%) than after a placebo (P 49/77pts 64% P = 0.02), particularly for ...
Kellett J G - - 1992
We constructed a decision analysis model based on data in the medical literature to estimate the possible outcomes of thrombolytic therapy in patients 50 to 80 years old with possible myocardial infarction. We used the model to test the most likely effects of treatment (determined by averaging the values in ...
Hoang K D - - 1992
Over the past decade there has been an increasing use of thrombolytic agents in the treatment of coronary artery disease, pulmonary embolism, and thromboembolic strokes. The use of thrombolytic agents has been most successful in treating acute myocardial infarction. When treatment with intravenous streptokinase or tissue plasminogen activator (tPA) is ...
Rieser M J - - 1992
A case of a patient with an acute anterior myocardial infarction (MI) and ventricular fibrillation is presented. The patient was resuscitated after cough-cardiopulmonary resuscitation (C-CPR) was administered in the emergency department. The patient received thrombolytic therapy without complication. Cough-CPR is a technique not in widespread use. With the advent of ...
Kleiman N S - - 1992
Mechanisms of death among patients who died within 18 h of enrollment in the Thrombolysis in Myocardial Infarction Phase II (TIMI II) study were analyzed. Of 3,339 patients enrolled, 32 died within the 1st 4 h and 31 died within the subsequent 14 h. Thirteen of the 63 patients had ...
Ostrow C L - - 1992
Thrombolytic therapy is the most recent advance in the treatment of acute myocardial infarction. Several research trials have been conducted worldwide in the last decade that have established that thrombolytic therapy has reduced mortality 50%, reduces the size of the infarction, improves left ventricular function, and reduces the incidence and ...
Woo K S - - 1992
Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue-plasminogen activator (rt-PA) (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 hours after onset, and intravenous heparin or dipyridamole therapy started at 3 hours, were studied prospectively. Their mean age was 59.6 +/- ...
Aufderheide T P - - 1992
This study prospectively determined the feasibility and accuracy of prehospital thrombolytic therapy candidate selection by base station emergency physicians. During a 6-month period, paramedics acquired and transmitted prehospital 12-lead electrocardiograms (ECGs) and then applied a thrombolytic therapy contraindication checklist. Emergency physicians interpreted prehospital ECGs and prospectively selected candidates for thrombolytic ...
Neuhaus K L - - 1992
Thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and anisoylated plasminogen streptokinase activator (APSAC) in myocardial infarction has been proved to reduce mortality. A new front-loaded infusion regimen of 100 mg of rt-PA with an initial bolus dose of 15 mg followed by an infusion of 50 mg over 30 min ...
Bates E R - - 1992
The reduction in morbidity and mortality associated with thrombolytic therapy in patients with acute myocardial infarction was initially attributed to early restoration of arterial patency, salvage of ischemic myocardium, and preservation of left ventricular function. Recombinant tissue plasminogen activator (rt-PA) was initially the favored thrombolytic agent because of selected studies ...
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