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Intravenous thrombolytic therapy in myocardial infarction: an analytical review
N W Shammas1, R Zeitler, P Fitzpatrick
1Department of Internal Medicine, University of Rochester Medical Center, New York 14642.
Insights
Streptokinase (SK) is a cost-effective thrombolytic agent for myocardial infarction (MI) compared to tissue plasminogen activator (tPA) and anisoylated plasminogen activator complex (APSAC). Comparative trials show no significant differences in mortality or ejection fraction (EF) between these agents.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Thrombolytic agents are crucial in managing acute myocardial infarction (MI).
- Three FDA-approved agents include streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasminogen activator complex (APSAC).
Purpose of the Study:
- To review the properties and physiological effects of SK, tPA, and APSAC.
- To compare their efficacy and safety in reducing mortality post-MI.
Main Methods:
- Review of properties and physiological effects of thrombolytic agents.
- Analysis of comparative trials and published megatrials.
Main Results:
- All agents reduce mortality post-MI; no significant differences found in mortality or ejection fraction (EF).
- tPA shows superior reperfusion at 90 min, but higher rates of reinfarction, interventional procedures, and strokes compared to SK in some studies.
- Streptokinase (SK) is identified as a more cost-effective option.
Conclusions:
- No significant clinical outcome differences (mortality, EF) between SK, tPA, and APSAC.
- SK presents a more cost-effective choice for acute MI management based on megatrial analysis.
Abstract:
The properties and physiological effects of three currently FDA-approved thrombolytic agents, streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasminogen activator complex (APSAC) are reviewed. All thrombolytic agents have been shown to reduce mortality postmyocardial infarction (MI). Comparative trials have failed to demonstrate a difference between the effects of tPA, SK, and APSAC on mortality. In addition, no consistent difference between the three agents on ejection fraction (EF) has been found despite a superior reperfusion rate with tPA at 90 min. Furthermore, reinfarction and interventional procedure rates were significantly higher after thrombolytic treatment, and the incidence of total strokes was higher with tPA than SK in some comparative studies. Based on analysis of the published megatrials, SK is a more cost-effective thrombolytic agent for patients with acute MI than tPA or APSAC.