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Updated: Jul 16, 2026

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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
レテプラス,アルテプラス,またはストレプトキナーゼによる急性心筋梗塞の血栓解消療法中のおよび後の血小板機能
1Internal Medicine III (Cardiology), University of Heidelberg, Heidelberg, Germany.
Circulation
|November 5, 1999
まとめ
急性心筋梗塞の血栓駆除薬療法は,血小板の集積に影響を及ぼします. レテプラスとストレプトキナーゼは,初期段階でアルテプラスと比較して血小板の集積が低いことを示した.
科学分野:
- 心臓病学 心臓病学
- 血液学 ヘマトロジ
- 薬理学 薬理学とは
背景:
- 急性心筋梗塞 (AMI) の血栓解離療法では,血小板機能が変化することがあります.
- 血小板の集積と受容体発現の変化は,再輸と再閉塞率に影響を与える可能性があります.
研究 の 目的:
- AMI患者の血小板集積および関連するマーカーに対する異なる血栓解消剤の効果を比較する.
- アルテプラス,レテプラス,またはストレプトキナーゼによる治療後の血小板凝集,P-セレクチン発現,およびフィブリノゲン結合を評価する.
主な方法:
- 4つの主要な臨床試験 (RAPID-1, RAPID-2, INJECT, GUSTO-3) に参加した126人の患者のデータを分析した.
- 患者は,アルテプラス,レテプラス (ダブルボラスまたはシングルボラス),またはストレプトキナーゼの様々な用量および投与レジメンを投与されました.
- 血小板集積 (PA),P-セレクチン発現,GP IIb/IIIaへのフィブリノゲン結合,溶性P-セレクチン,プロトロンビン断片F1およびF2,トロンビン-アンチトロンビン複合体 (TAT),およびアンチトロンビンIII (ATIII) を測定した.
主要な成果:
- GP IIb/IIIaへのPAとフィブリノゲンの結合は,10+10-Uレテプラスまたはストリープトキナーゼを投与した1時間および2時間後に有意に減少した.
- すべての治療群では,F1とF2の断片とTATレベルが増加し,トロンビン生成を示した.
- アンチトロンビンIIIレベルは,すべての血栓駆除療法グループで有意に低下しました.
結論:
- レテプラスとストレプトキナーゼは,アルテプラスと比較してPAの早期減少がより大きく示されました.
- ダブルボラスレテプラス (10+10U) とストレプトキナーゼは,加速されたアルテプラスと比較して,1時間および2時間後に低血圧をもたらしました.
- また,フィブリノゲンのGP IIb/IIIaへの結合は,レテプラス投与後の最初の2時間において,加速アルテプラス投与と比較して低かった.
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