Document Detail

Repeat infusion of recombinant tissue-type plasminogen activator in patients with acute myocardial infarction and early recurrent myocardial ischemia.
MedLine Citation:
PMID:  2120309     Owner:  NLM     Status:  MEDLINE    
When conventional treatment of patients with early clinical reinfarction after thrombolytic therapy fails, mechanical revascularization may be attempted. An alternative strategy, repeat thrombolytic infusions, is reported. Fifty-two patients with acute myocardial infarction were treated with one or two additional thrombolytic infusions of recombinant tissue-type plasminogen activator (rt-PA) because of nonsustained ischemia after initial treatment with rt-PA or streptokinase. Thirty-five patients received the second infusion within 1 h of the first; 13 patients received the second infusion 1 to 72 h after the first and 4 patients received it later during their hospitalization. Bleeding complications occurred in 10 patients (19%); however, most of these were minor (no intracranial bleeding) and only 2 patients required blood transfusion. In 14 patients in whom the decrease in fibrinogen and plasminogen levels was measured after the first and second infusions, this decrease was only 25% and 63%, respectively--only slightly higher than the 22% and 53% decreases measured in 63 patients who had only one rt-PA infusion. In 44 patients (85%), the acute ischemia resolved completely within 1 h after initiation of the second infusion. In 23 patients (44%), pain and ST segment elevation did not recur and invasive coronary intervention was avoided. Thus, repeat rt-PA infusions can stabilize a substantial number of patients with acute reinfarction and, even when relief is temporary, repeat rt-PA infusions can minimize myocardial damage while patients await mechanical revascularization.
G I Barbash; H Hod; A Roth; H E Faibel; Y Mandel; H I Miller; S Rath; Y H Zahav; B Rabinowitz; U Seligsohn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  16     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1990 Oct 
Date Detail:
Created Date:  1990-11-21     Completed Date:  1990-11-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  779-83     Citation Subset:  AIM; IM    
Cardiology Institute, Sheba Medical Center, Tel Aviv, Ramat-Gan, Israel.
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MeSH Terms
Hemorrhage / chemically induced
Middle Aged
Myocardial Infarction / drug therapy*
Recombinant Proteins / therapeutic use
Streptokinase / therapeutic use
Thrombolytic Therapy*
Time Factors
Tissue Plasminogen Activator / therapeutic use*
Reg. No./Substance:
0/Recombinant Proteins; EC 3.4.-/Streptokinase; EC Plasminogen Activator

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