Intracoronary thrombolysis with an acylated streptokinase-plasminogen activator (BRL 26921) in patients with acute myocardial infarction

• Published in: Journal of the American College of Cardiology 1984-08, Vol.4 (2), p.357-363
• Main Authors: Kasper, Wolfgang, Erbel, Raimund, Meinertz, Thomas, Drexler, Michael, Rückel, Andreas, Pop, Tiberius, Prellwitz, Winfried, Meyer, Jürgen
• Format: Article
• Language: English
• Subjects: Aged; Anistreplase; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Coronary Vessels - pathology; Drug Evaluation; Factor V - analysis; Factor VIII - analysis; Female; Fibrin Fibrinogen Degradation Products - analysis; Fibrinogen - analysis; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - drug therapy; Myocardial Infarction - pathology; Plasminogen - adverse effects; Plasminogen - analysis; Plasminogen - therapeutic use; Streptokinase - adverse effects; Streptokinase - therapeutic use; Thrombin Time
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(84)80226-0

The fibrinolytic efficacy and systemic effects on coagulation variables of intracoronary administration of an at vlated streptokinase-plasminogen complex (BRL 26921) were assessed in 23 patients with an acute transmural myocardial infarction. The infarct vessel was totally occluded in 22 patients and subtotally stenosed in 1 patient. Reperfusion was achieved in a total of 17 patients (74%), in 2 patients with the use of a guide wire. Reperfusion time in those patients treated with BRL 26921 alone amounted to 42 ± 37 minutes. Reocclusion occurred in two patients subsequently. Four patients died; in two of these, intracoronary thrombolysis was unsuccessful. Reptilase time increased from 13 ± 3 to 49 ± 31 seconds (p < 0.001), fibrinogen levels decreased from 280 ± 65 to 126 ± 76 mg% (p < 0.001). Factor V decreased from 96 ± 11 to 53 ± 26% (p < 0.001), and factor VIII from 99 ± 1 to 55 ± 36% (p < 0.001). Peripheral hyperplasminemia, denned as a reduction of fibrinogen (< 100 mg%) with a reduction of factor V and VIII (< 75%) simultaneously occurred in eight patients. Six (75%) of these 8 patients demonstrated reperfusion, whereas 9 (64%) of 14 patients without peripheral hyperplasminemia were also successfully reperfused. Bleeding complications occurred in two patients who demonstrated hyperplasminemia. Thus, effective intracoronary thrombolysis could be achieved with only minor effects on peripheral coagulation variables in the majority of patients.