Document Detail


Does impairment of renal and hepatic function influence the metabolism of thrombolytics in patients with myocardial infarction?
MedLine Citation:
PMID:  18444516     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Thrombolytic agents activate plasminogen and induce a systemic fibrinolytic and anticoagulant state. Two thrombolytic drugs are used frequently in practice: streptokinase (SK) and alteplase (t-PA). Streptokinase mainly undergoes renal elimination with a half-life of 11-17 min, while alteplase is eliminating by the liver with a half-life of 4-6 min. Our goal was to examine whether renal and hepatic function influence the elimination and metabolism of thrombolytics and the efficacy of percutaneous coronary intervention (PCI) after using alteplase or streptokinase. 416 patients with myocardial infarction (MI) were treated from January 2001 to December 2003 (228 male and 189 female). Alteplase was used in 9 men and 6 women (mean age: 53.88 +/- 9.61 vs. 65.33 +/- 9.87 years, p = 0.07). Patients who underwent rescue PCI after administration of alteplase had slightly higher hepatic enzyme levels/alanine transaminase (ALT): 47.85 vs. 41.4 U/l; gamma-glutamyl transpeptidase (GGT): 69.5 vs. 44.8 U/l/. All patients treated with alteplase survived, rescue PCI was done in 8 cases. Streptokinase was used in 36 men and 28 women (mean age: 63.33 +/- 10.51 vs. 63 +/- 12.03 years, p = 0.9). We did not find a difference between serum creatinine levels of patients who received streptokinase and underwent PCI as compared to those who had not. Rescue PCI was done in 16 cases. 12 patients died in this group. In conclusion we have not found a significant correlation between the use of the thrombolytics and hepatic or renal function; this could indicate that such a slight impairment of liver and renal function does not influence pharmacokinetic properties of thrombolytics.
Authors:
Z Vincze; B Brugos
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Die Pharmazie     Volume:  63     ISSN:  0031-7144     ISO Abbreviation:  Pharmazie     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-04-30     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9800766     Medline TA:  Pharmazie     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  245-6     Citation Subset:  IM    
Affiliation:
3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Angioplasty, Balloon
Female
Fibrinolytic Agents / pharmacokinetics*
Half-Life
Humans
Kidney Diseases / metabolism*
Kidney Function Tests
Liver Diseases / metabolism*
Liver Function Tests
Male
Middle Aged
Myocardial Infarction / metabolism*
Retrospective Studies
Streptokinase / pharmacokinetics
Tissue Plasminogen Activator / pharmacokinetics
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator

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