Thrombolytic therapy in acute myocardial infarction : Comparison of procoagulant effects of streptokinase and alteplase regimens with focus on the Kallikrein system and plasmin

Thrombolytic therapy in patients with acute myocardial infarction (AMI) is hampered by procoagulant effects. In vitro studies have indicated that plasmin stimulation activates the kallikrein-contact-phase system, resulting in thrombin activation. This prospective comparative study was designed to ex...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1998-12, Vol.98 (23), p.2527-2533
Main Authors: HOFFMEISTER, H. M, SZABO, S, KASTNER, C, BEYER, M. E, HELBER, U, KAZMAIER, S, WENDEL, H. P, HELLER, W, SEIPEL, L
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Female
Fibrinolysin - analysis
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Humans
Kallikreins - analysis
Male
Medical sciences
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - drug therapy
Pharmacology. Drug treatments
Streptokinase - administration & dosage
Streptokinase - therapeutic use
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
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Summary:Thrombolytic therapy in patients with acute myocardial infarction (AMI) is hampered by procoagulant effects. In vitro studies have indicated that plasmin stimulation activates the kallikrein-contact-phase system, resulting in thrombin activation. This prospective comparative study was designed to examine the procoagulant effects of streptokinase or alteplase in AMI. Sixty-one patients with AMI received 1.5 million U of streptokinase or front-loaded alteplase (up to 100 mg) and systemic heparin. Twenty-four patients with AMI and no thrombolytic therapy and 30 control subjects were examined for comparison. Molecular markers of thrombin, plasmin activation, and coagulation activities were determined before therapy and serially for up to 10 days. Moderate thrombin (initial thrombin-antithrombin [TAT] complex 18+/-5 versus 4+/-0.3 microg/L, P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.98.23.2527