Document Detail

The role of thrombolytic drugs in the management of myocardial infarction. Comparative clinical trials.
MedLine Citation:
PMID:  8960443     Owner:  NLM     Status:  MEDLINE    
Optimal thrombolytic therapy in acute myocardial infarction must aim to achieve early and complete reperfusion of the infarct related coronary artery. Establishment of normal coronary flow (Thrombolysis in Myocardial Infarction [TIMI] grade 3) is the key correlate of improved survival. Three large-scale clinical trials, the Reteplase Angiographic Phase II International Dose-finding Study (RAPID 1), the Reteplase vs Alteplase Patency Investigation During Acute Myocardial Infarction Study (RAPID 2), and the International Joint Comparison of Thrombolytics Study (INJECT), have evaluated the comparative efficacy and safety of reteplase, a new, rapid-acting thrombolytic agent that offers the practical clinical convenience of bolus dosing. RAPID 1 and 2 demonstrated that reteplase was associated with superior early coronary artery patency rates compared with alteplase, whether alteplase was infused over 3 h or over 90 min. Further, the TIMI 3 flow rates achieved in reteplase-treated patients at 60 min were comparable to those achieved at 90 min with the accelerated alteplase dosing regimen. The INJECT trial showed that reteplase resulted in comparable mortality and clinical benefits to those achieved with streptokinase. All three studies demonstrated that reteplase therapy was not associated with an increase in bleeding complications or other adverse clinical events. The simple double-bolus regimen of reteplase administration may permit earlier initiation of thrombolysis with fewer dosing errors than with continuous infusion regimens and thus afford a reduction in the morbidity and mortality risks in patients with acute myocardial infarction.
W D Weaver
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European heart journal     Volume:  17 Suppl F     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-03-13     Completed Date:  1997-03-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  9-15     Citation Subset:  IM    
MITI Coordinating Center, Seattle, Washington 98102, USA.
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MeSH Terms
Controlled Clinical Trials as Topic
Fibrinolytic Agents / therapeutic use*
Myocardial Infarction / diagnosis,  drug therapy*,  enzymology
Plasminogen Activators / metabolism,  therapeutic use*
Recombinant Proteins / therapeutic use
Thrombolytic Therapy* / methods
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Recombinant Proteins; 133652-38-7/reteplase; EC 3.4.21.-/Plasminogen Activators; EC Plasminogen Activator

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