Which thrombolytic agent is preferred ?
Three thrombolytic agents (which reduce mortality) are commonly available in the UK: streptokinase, anistreplase and tissue plasminogen activator (tPA), of which streptokinase is the cheapest and tPA the most expensive. In ISIS-3 (Third Inter-national Study of Infarct Survival) all three agents were found to be equally effective and in the GISSI-2 (Gruppo Italiano per lo Studio della Sopraviviena nell lnfarcto Micocardioco) study both tPA and streptokinase were equally effective. However, in both these studies there was increased risk of haemorrhage with tPA. In the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator) trial, tPA given in an accelerated manner was particularly useful in young men with anterior wall myocardial infarction, tPA is now given to patients previously treated with streptokinase because the development of anti-streptokinase antibodies puts them at risk of allergic reactions and reduces the efi'ectiveness of thrombolysis.
The best thrombolytic treatment currently available accelerated tPA achieves grade 3 patency in only 54% of patients, which is better than streptokinase (30% of patients had TIMI grade 3). The difference in vessel patehcy achieved by tissue plasminogen activator and streptokinase treatment has not resulted in a significant difference in mortality in most trials. Although the GUSTO-1 trial showed reduced mortality with tissue plasminogen activator treatment, this benefit was partly offset by an excess of strokes in thistreatment group. The current contender for the primary position held by accelerated tPA seems to be reteplase. Reteplase differs from tissue plasminogen activator at two molecular points, and deletion of these molecular domains contributes to its longer half-life. Reteplase is conveniently administered: two l0 unit boluses are given 30 minutes apart. It has been shown to be comparable with tPA. In the INJECT (International Joint Efficacy Comparison of Thrombolytics) trial patients in the reteplase group had significantly fewer side-effects such as atrial fibrillation and cardiogenic shock when compared to the streptokinase group.
Lexo edhe:
Three thrombolytic agents (which reduce mortality) are commonly available in the UK: streptokinase, anistreplase and tissue plasminogen activator (tPA), of which streptokinase is the cheapest and tPA the most expensive. In ISIS-3 (Third Inter-national Study of Infarct Survival) all three agents were found to be equally effective and in the GISSI-2 (Gruppo Italiano per lo Studio della Sopraviviena nell lnfarcto Micocardioco) study both tPA and streptokinase were equally effective. However, in both these studies there was increased risk of haemorrhage with tPA. In the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator) trial, tPA given in an accelerated manner was particularly useful in young men with anterior wall myocardial infarction, tPA is now given to patients previously treated with streptokinase because the development of anti-streptokinase antibodies puts them at risk of allergic reactions and reduces the efi'ectiveness of thrombolysis.
The best thrombolytic treatment currently available accelerated tPA achieves grade 3 patency in only 54% of patients, which is better than streptokinase (30% of patients had TIMI grade 3). The difference in vessel patehcy achieved by tissue plasminogen activator and streptokinase treatment has not resulted in a significant difference in mortality in most trials. Although the GUSTO-1 trial showed reduced mortality with tissue plasminogen activator treatment, this benefit was partly offset by an excess of strokes in thistreatment group. The current contender for the primary position held by accelerated tPA seems to be reteplase. Reteplase differs from tissue plasminogen activator at two molecular points, and deletion of these molecular domains contributes to its longer half-life. Reteplase is conveniently administered: two l0 unit boluses are given 30 minutes apart. It has been shown to be comparable with tPA. In the INJECT (International Joint Efficacy Comparison of Thrombolytics) trial patients in the reteplase group had significantly fewer side-effects such as atrial fibrillation and cardiogenic shock when compared to the streptokinase group.
loading...
Lexo edhe:
