Document Detail


Reteplase: a review of its use in the management of thrombotic occlusive disorders.
MedLine Citation:
PMID:  16913828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reteplase (Retavase) is a plasminogen activator, mimicking endogenous tissue plasminogen activator (t-PA), a serine protease, converting plasminogen to plasmin and thereby precipitating thrombolysis. It is a third-generation recombinant form of t-PA that operates in the presence of fibrin (i.e. it is fibrin specific). Reteplase can be administered as a bolus dose (nonweight-based) rather than an infusion, which promotes rapid and safe administration. The ease of administration of this reteplase dosage regimen (two 10U bolus doses, each over 2 minutes, 30 minutes apart) is conducive to prehospital initiation of thrombolytic treatment in patients with ST-segment elevation myocardial infarction (STEMI), which reduces the time to treatment, a critical factor in improving long-term survival. In large randomized clinical trials of patients with STEMI, reteplase was superior to alteplase for coronary artery patency (according to TIMI [thrombolysis in myocardial infarction] flow) at 60 and 90 minutes, but there was no significant difference between agents for mortality rate and incidence of intracranial bleeding. The 35-day mortality rates were equivalent for reteplase and streptokinase recipients; there was reduced incidence of some cardiac events with reteplase versus streptokinase, but a greater incidence of hemorrhagic stroke. Reteplase has also shown thrombolytic efficacy (in nonapproved indications) as a catheter-directed intra-arterial or intravenous infusion for peripheral vessel occlusions, as 5-minute bolus doses (in 1U increments) for acute ischemic stroke, as a low-dose solution for occluded catheters or grafts, and as an intravenous double bolus for massive pulmonary embolism. Across studies in these indications, the incidence of bleeding complications associated with reteplase treatment appeared to be similar to that associated with other thrombolytic agents. With its efficacy, and the ease of administration of the bolus doses potentially minimizing dosage errors when treatment is administered under time pressure, reteplase is a valuable option for pre- or in-hospital thrombolytic treatment in patients with STEMI, and is a useful thrombolytic for the treatment of the other thrombotic occlusive disorders described.
Authors:
Dene Simpson; M Asif A Siddiqui; Lesley J Scott; Daniel E Hilleman
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of cardiovascular drugs : drugs, devices, and other interventions     Volume:  6     ISSN:  1175-3277     ISO Abbreviation:  Am J Cardiovasc Drugs     Publication Date:  2006  
Date Detail:
Created Date:  2006-08-17     Completed Date:  2006-12-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100967755     Medline TA:  Am J Cardiovasc Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  265-85     Citation Subset:  IM    
Affiliation:
Adis International Inc., Yardley, Pennsylvania 19067, USA. demail@adis.com
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MeSH Terms
Descriptor/Qualifier:
Arterial Occlusive Diseases / drug therapy*
Brain Ischemia / drug therapy
Fibrinolytic Agents / therapeutic use*
Humans
Myocardial Infarction / drug therapy
Peripheral Vascular Diseases / drug therapy
Pulmonary Embolism / drug therapy
Recombinant Proteins / adverse effects,  pharmacology,  therapeutic use
Stroke / drug therapy
Thrombosis / drug therapy*
Tissue Plasminogen Activator / adverse effects,  pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Recombinant Proteins; 133652-38-7/reteplase; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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