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New developments in thrombolytic therapy.

D Collen, H K Gold

    Verhandelingen - Koninklijke Academie Voor Geneeskunde Van Belgie
    |January 1, 1989
    PubMed
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    Thrombolytic therapy using agents like streptokinase (SK) and recombinant tissue-type plasminogen activator (rt-PA) can treat cardiovascular disease. While rt-PA offers higher efficacy, cost remains a factor in choosing between agents for acute myocardial infarction (AMI).

    Area of Science:

    • Cardiology
    • Pharmacology
    • Thrombosis Research

    Background:

    • Cardiovascular diseases are a leading cause of death and disability.
    • Thrombotic complications are a major concern in cardiovascular disease.
    • Thrombolytic therapy with plasminogen activators offers a potential treatment strategy.

    Purpose of the Study:

    • To review available and investigational thrombolytic agents for cardiovascular diseases.
    • To compare the efficacy and fibrin-specificity of different thrombolytic agents.
    • To discuss current treatment considerations and future developments in thrombolytic therapy.

    Main Methods:

    • Review of existing literature on thrombolytic agents.
    • Comparison of efficacy and fibrin-specificity data for streptokinase (SK), urokinase (UK), recombinant tissue-type plasminogen activator (rt-PA), anisoylated plasminogen streptokinase activator complex (APSAC), and single chain urokinase-type plasminogen activator (scu-PA).

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  • Analysis of clinical outcomes including infarct size, ventricular function, mortality, and coronary artery recanalization rates.

    • Main Results:

    • First-generation agents like SK and UK show moderate efficacy.
    • rt-PA demonstrates higher efficacy and fibrin-specificity compared to SK.
    • SK recanalizes 40-45% of coronary arteries in acute myocardial infarction (AMI) and reduces mortality by 25%; rt-PA achieves 65-70% reperfusion.
    • SK, rt-PA, and APSAC have shown reductions in infarct size, improved ventricular function, or decreased mortality, but direct comparative trials are pending.

    Conclusions:

    • The choice between SK and rt-PA for AMI treatment depends on balancing cost and efficacy.
    • Current thrombolytic agents have limitations including suboptimal efficacy, limited fibrin-specificity, and bleeding risks.
    • Future developments focus on improving efficacy and fibrin-specificity through agent combinations, engineered molecules, and targeted delivery systems.