Document Detail


Thrombolytic therapy in Europe: current status.
MedLine Citation:
PMID:  11824000     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Thrombolytic therapy is a practical, effective approach to the management of acute myocardial infarction that is widely used in Europe today. Early European trials demonstrated a clear reduction in mortality in patients who received thrombolytic therapy compared with those given conventional treatment. The findings of experimental studies suggest that early reperfusion of the infarct-related artery reduces myocardial damage, which results in the preservation of left ventricular function and, in turn, may improve survival. Although tissue plasminogen activator (t-PA) has been shown to produce more rapid and complete reperfusion than streptokinase, two large-scale clinical trials in which t-PA was given as a standard 3- or 4-h infusion provided no evidence of a survival advantage with this agent. However, the accelerated t-PA regimen used in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) study was associated with a lower mortality than streptokinase or a combination of t-PA and streptokinase, thus lending support to the 'open artery' theory. Two recent studies conducted in Europe, the Grampian Region Early Anistreplase Trial (GREAT) and the European Myocardial Infarction Project (EMIP), have demonstrated the feasibility, safety, and efficacy of early thrombolytic therapy before admission to hospital. In GREAT, anistreplase (APSAC) was administered at home by general practitioners. In EMIP, this same agent was given by emergency medical personnel. In both studies, pre-hospital administration reduced the time between the onset of symptoms and initiation of thrombolysis and was associated with a lower mortality rate. Recent data from the European Cooperative Group Study show that the benefits of thrombolytic therapy are maintained for up to 5 years. Research continues in an effort to develop safer and more effective thrombolytic agents. Educational efforts to familiarize the public with the symptoms of myocardial infarction and the development of more rapid, efficient emergency response systems may also improve the outcome of thrombolytic therapy by shortening the time between symptom onset and thrombolytic drug administration.
Authors:
A Vahanian
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European heart journal     Volume:  17 Suppl E     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1996 Sep 
Date Detail:
Created Date:  2002-02-04     Completed Date:  2002-02-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  21-7     Citation Subset:  IM    
Affiliation:
Hôpital Tenon, Service de Cardiologie, 4 Rue de la Chine, 75970 Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Anistreplase / therapeutic use
Drug Administration Schedule
Emergency Treatment
Europe
Fibrinolytic Agents / administration & dosage,  therapeutic use*
Humans
Myocardial Infarction / drug therapy*,  mortality
Myocardial Reperfusion / trends
Randomized Controlled Trials as Topic
Streptokinase / therapeutic use
Survival Analysis
Tissue Plasminogen Activator / therapeutic use
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 81669-57-0/Anistreplase; EC 3.4.-/Streptokinase; 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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