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New developments in thrombolytic therapy.

D Collen1, H K Gold

  • 1Center for Thrombosis and Vascular Research, University of Leuven, Belgium.

Advances in Experimental Medicine and Biology
|January 1, 1990
PubMed
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Thrombolytic agents like streptokinase and recombinant tissue-type plasminogen activator (rt-PA) treat cardiovascular disease by dissolving blood clots. Recombinant tissue-type plasminogen activator (rt-PA) shows higher efficacy in reperfusion compared to streptokinase.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Hematology

Background:

  • Thrombotic cardiovascular diseases are leading causes of death and disability.
  • Thrombolysis, using plasminogen activators, dissolves blood clots by converting plasminogen to plasmin.
  • Plasmin degrades fibrin but can also affect hemostatic components, leading to bleeding risks.

Purpose of the Study:

  • To review current thrombolytic agents for acute myocardial infarction.
  • To compare the efficacy and safety of different thrombolytic therapies.
  • To assess the potential of thrombolytic therapy as a routine treatment for acute myocardial infarction.

Main Methods:

  • Review of clinical data and comparative studies of thrombolytic agents.
  • Analysis of efficacy, fibrin-specificity, and side effect profiles.

Related Experiment Videos

  • Examination of cost-effectiveness and impact on mortality and infarct size.

    • Main Results:

    • Recombinant tissue-type plasminogen activator (rt-PA) is more effective and fibrin-specific than streptokinase for acute myocardial infarction.
    • Streptokinase recanalizes 40-45% of coronary arteries and reduces mortality by 25% at a lower cost.
    • rt-PA achieves higher reperfusion rates (65-70%) but at a significantly higher cost; bleeding and reocclusion rates are similar for both.
    • APSAC offers similar efficacy to streptokinase with bolus administration advantage.
    • scu-PA demonstrates greater fibrin-specificity than urokinase, with limited comparative data.

    Conclusions:

    • Thrombolytic therapy is poised to become routine for early acute myocardial infarction.
    • While rt-PA shows superior reperfusion, its mortality benefit over streptokinase requires further large-scale trials.
    • The choice of thrombolytic agent involves balancing efficacy, safety, cost, and administration method.