Document Detail


Alteplase: descendancy in myocardial infarction, ascendancy in stroke.
MedLine Citation:
PMID:  11772304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tissue type plasminogen activator is available, through recombinant technology, for thrombolytic use as alteplase. Alteplase is relatively clot specific and should cause less bleeding side effects than the non-specific agents such as streptokinase. Alteplase has been used successfully in evolving myocardial infarction (MI) to reopen occluded coronary arteries. It is probably equally effective or superior to streptokinase in opening arteries and reducing mortality in MI. Alteplase is most effective when given early in MI and is probably ineffective when given 12 h after the onset of symptoms. The effectiveness of alteplase in MI can be increased by front loading with a bolus of 15 mg, followed by an infusion of 50 mg over 30 min and 35 mg over 60 min. Percutaneous transluminal coronary angioplasty or stenting is associated with a greater patency and lower rates of serious bleeding, recurrent ischaemia and death than alteplase in MI and is likely to take over from alteplase as the standard MI treatment. A reduced dose of alteplase to increase coronary artery patency prior to angioplasty may be useful in MI. An exciting new indication for the use of alteplase is in stroke, where it has become the first beneficial intervention. Alteplase is used to reopen occluded cerebral vessels but is associated with an increased risk of intracerebral haemorrhage. Alteplase is beneficial if given within 3 h of the onset of stroke but not after this time period. Therefore, the next challenge is to increase the percentage of people being diagnosed and treated within this period. Clinical trials have not established a role for alteplase in the treatment of acute coronary syndromes or deep vein thrombosis. However, alteplase is useful in treating pulmonary thromboembolism and peripheral vascular disease.
Authors:
S A Doggrell
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on investigational drugs     Volume:  10     ISSN:  1354-3784     ISO Abbreviation:  Expert Opin Investig Drugs     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2002-01-04     Completed Date:  2002-03-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9434197     Medline TA:  Expert Opin Investig Drugs     Country:  England    
Other Details:
Languages:  eng     Pagination:  2013-29     Citation Subset:  IM    
Affiliation:
Department of Physiology and Pharmacology, The University of Queensland, Brisbane, 4072 Queensland, Australia. s_doggrell@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon
Clinical Trials as Topic
Coronary Disease / drug therapy
Fibrinolytic Agents / therapeutic use
Humans
Myocardial Infarction / drug therapy*,  surgery
Peripheral Vascular Diseases / drug therapy
Plasminogen Activators / administration & dosage,  adverse effects,  therapeutic use*
Pulmonary Embolism / drug therapy
Stroke / drug therapy*
Tissue Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Venous Thrombosis / drug therapy
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator

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