Document Detail


Role of heparin in coronary thrombolysis.
MedLine Citation:
PMID:  1555478     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although the benefits of coronary thrombolysis are well established, the optimal therapeutic strategy for ensuring rapid and sustained coronary artery patency remains controversial. The available data suggest that the success of coronary thrombolysis depends not only on the induction of clot lysis, but also on the extent to which procoagulant activity that promotes recurrent thrombosis is inhibited. Procoagulant activity increases almost immediately in patients treated with fibrinolytic agents, and persistent increases in thrombin activity have been associated with recurrent coronary thrombosis. Heparin administered intravenously appears to markedly attenuate the thrombin activity associated with thrombolysis and, in patients treated with tissue plasminogen activator (t-PA), prevents early recurrent coronary thrombosis. The results of clinical trials of coronary thrombolysis indicate that conjunctive treatment of patients with heparin improves survival compared with treatment with fibrinolytic agents alone. Although recent clinical trials in which patients were treated with streptokinase suggested that 12,500 units of heparin administered subcutaneously twice daily decreases mortality, this dosage regimen does not induce therapeutic levels of anticoagulation within the first 24 h in most patients. The failure to achieve early therapeutic anticoagulation may account for the lack of mortality benefit in trials in which patients given t-PA were treated with conjunctive subcutaneous heparin therapy. Thus, the available experimental and clinical data suggest that intravenous heparin should be given to patients treated with fibrinolytic agents for acute myocardial infarction.
Authors:
P R Eisenberg
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Chest     Volume:  101     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1992 Apr 
Date Detail:
Created Date:  1992-05-07     Completed Date:  1992-05-07     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  131S-139S     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110.
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MeSH Terms
Descriptor/Qualifier:
Drug Therapy, Combination
Fibrinolysis / drug effects
Fibrinolytic Agents / pharmacology,  therapeutic use
Heparin / pharmacology,  therapeutic use*
Humans
Myocardial Infarction / drug therapy*
Thrombolytic Therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 9005-49-6/Heparin

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


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