Circulation, Vol 70, 1012-1017, Copyright © 1984 by American Heart Association
D Collen, EJ Topol, AJ Tiefenbrunn, HK Gold, ML Weisfeldt, BE Sobel, RC Leinbach, JA Brinker, PA Ludbrook and I Yasuda
Forty-five patients with acute transmural myocardial infarction and
angiographically confirmed complete coronary occlusion were prospectively
randomized, two for one, to treatment of acute coronary thrombosis with
intravenous recombinant human tissue-type plasminogen activator (rt-PA) or
placebo. Each of five additional consecutive patients was treated with a
high dose of rt-PA for 2 hr. Twenty-five of 33 patients (75%) receiving 0.5
to 0.75 mg/kg of rt-PA over 30 to 120 min had angiographically proven
recanalization within 90 min of initiation of therapy. Only one of 14
patients given placebo had spontaneous recanalization within 45 min (p less
than .001). Thirteen placebo-treated patients were crossed over to the
intracoronary rt-PA group. Nine (69%) exhibited subsequent recanalization
within 45 min. Levels of circulating fibrinogen decreased after treatment
with rt-PA by an average of only 8% of baseline values. None of the
patients manifested a depletion of fibrinogen level to below 100 mg/dl. Six
patients who were completely unresponsive to rt-PA were subsequently
treated with intracoronary streptokinase and none responded. Thus, either
intravenous or intracoronary rt-PA induced coronary thrombolysis without
eliciting clinically significant fibrinogenolysis in patients with evolving
myocardial infarction due to thrombotic coronary occlusion.
ARTICLES
Coronary thrombolysis with recombinant human tissue-type plasminogen activator: a prospective, randomized, placebo-controlled trial
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