Dose-related efficacy and bleeding complications of double-chain tissue plasminogen activator in acute myocardial infarction

Turi, Zoltan G., Goldberg, Sheldon, LittleJohn, Judith K., VanderArk, Condon, Shadoff, Neal, Karlsberg, Ronald, Williams, John, Butman, Samuel, Stadius, Michael L., Wise, Kent, Buchbinder, Maurice, Genton, Edward, Laskey, Warren K., DeMaria, Anthony, White, Chris, Sheehan, Florence, Comp, Philip C., Wynne, Joshua, Batson-Fowler, Gail and Edwards, Suzanne (1993) Dose-related efficacy and bleeding complications of double-chain tissue plasminogen activator in acute myocardial infarction. American Journal of Cardiology, 71 12: 1009-1014. doi:10.1016/0002-9149(93)90564-S


Author Turi, Zoltan G.
Goldberg, Sheldon
LittleJohn, Judith K.
VanderArk, Condon
Shadoff, Neal
Karlsberg, Ronald
Williams, John
Butman, Samuel
Stadius, Michael L.
Wise, Kent
Buchbinder, Maurice
Genton, Edward
Laskey, Warren K.
DeMaria, Anthony
White, Chris
Sheehan, Florence
Comp, Philip C.
Wynne, Joshua
Batson-Fowler, Gail
Edwards, Suzanne
Title Dose-related efficacy and bleeding complications of double-chain tissue plasminogen activator in acute myocardial infarction
Journal name American Journal of Cardiology   Check publisher's open access policy
ISSN 0002-9149
Publication date 1993-05-01
Sub-type Article (original research)
DOI 10.1016/0002-9149(93)90564-S
Volume 71
Issue 12
Start page 1009
End page 1014
Total pages 6
Place of publication Bridgewater, NJ, United States
Publisher Excerpta Medica
Language eng
Formatted abstract
Although the efficacy of recombinant tissue-type Plasminogen activator (rt-PA) in acute myocardial infarction has been demonstrated, little formal dose-ranging information is available. This study examined the use of duteplase, the double-chain rt-PA subsequently used in the Third International Study of infarct Survival, in a multicenter trial of 267 patients with evolving acute myocardial infarction assigned to receive 1 of 6 weight-adjusted doses. The primary end point was infarct vessel patency after 90 minutes of drug infusion. Patency was defined as Thrombolysis in Myocardial infarction trial grade 2 or 3 perfusion, and was determined by an independent core laboratory masked to treatment assignment. Patency was present in 48% of patients receiving the lowest dose range and 78% of those receiving the highest, with an association between thrombolytic dose and patency (p = 0.009). The frequency of serious bleeding complications also correlated with the total dose of rt-PA infused (p = 0.003). Bleeding complications were primarily related to instrumentation; blood toss requiring transfusion or otherwise deemed clinically significant occurred in 12% of patients (central nervous system hemorrhage occurred in 1.1%). Thus, higher doses of rt-PA are associated both with increased efficacy and increased risk of serious bleeding complications. Weight-adjusted dosing may provide an optimal risk-benefit ratio for thrombolysis during acute myocardial infarction.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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