1
|
Leucker TM, Osburn WO, Reventun P, Smith K, Claggett B, Kirwan BA, de Brouwer S, Williams MS, Gerstenblith G, Hager DN, Streiff MB, Solomon SD, Lowenstein CJ. Effect of Crizanlizumab, a P-Selectin Inhibitor, in COVID-19: A Placebo-Controlled, Randomized Trial. JACC Basic Transl Sci 2021; 6:935-945. [PMID: 34904132 PMCID: PMC8653991 DOI: 10.1016/j.jacbts.2021.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022]
Abstract
Severe COVID-19 is characterized by vascular inflammation and thrombosis, including elevations of P-selectin, a marker released by activated endothelial cells that mediates vascular inflammation. We tested the effect of crizanlizumab, an antibody to P-selectin, on biomarkers of inflammation and thrombosis in patients with COVID-19 in a randomized, placebo-controlled, double-blind clinical trial. Crizanlizumab decreased soluble P-selectin levels in patients with COVID-19. Crizanlizumab increased D-dimer and decreased prothrombin fragment 1.2 in patients with COVID-19. Crizanlizumab may induce endogenous thrombolysis in the setting of COVID-19.
COVID-19 is characterized by vascular inflammation and thrombosis, including elevations in P-selectin, a mediator of inflammation released by endothelial cells. We tested the effect of P-selectin inhibition on biomarkers of thrombosis and inflammation in patients with COVID-19. Hospitalized patients with moderate COVID-19 were randomly assigned to receive either placebo or crizanlizumab, a P-selectin inhibitor, in a double-blind fashion. Crizanlizumab reduced P-selectin levels by 89%. Crizanlizumab increased D-dimer levels by 77% and decreased prothrombin fragment. There were no significant differences between crizanlizumab and placebo for clinical endpoints. Crizanlizumab was well tolerated. Crizanlizumab may induce thrombolysis in the setting of COVID-19. (Crizanlizumab for Treating COVID-19 Vasculopathy [CRITICAL]; NCT04435184)
Collapse
Affiliation(s)
- Thorsten M Leucker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William O Osburn
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paula Reventun
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kimberley Smith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bridget-Anne Kirwan
- SOCAR Research SA, Nyon, Switzerland.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | | | - Marlene S Williams
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David N Hager
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charles J Lowenstein
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Chang A, Llinas EJ, Chen K, Llinas RH, Marsh EB. Shorter Intensive Care Unit Stays? Stroke 2018; 49:1521-1524. [DOI: 10.1161/strokeaha.118.021398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Adam Chang
- From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Edward J. Llinas
- From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen Chen
- From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rafael H. Llinas
- From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Elisabeth B. Marsh
- From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
3
|
Patel R, Kumar A, Nishizawa K, Kumar N. Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator. BMJ Case Rep 2018; 2018:bcr-2017-222686. [PMID: 29374642 DOI: 10.1136/bcr-2017-222686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare condition that requires urgent surgical intervention in order to prevent permanent neurological deficit. SSEH commonly presents as a paraparesis or tetraparesis. SSEH presenting as a hemiparesis is less common and in such situations, it can be mistaken for a cerebrovascular accident (CVA). Thrombolytic or anticoagulant treatment for CVA can potentially worsen the neurological deficit. We report one such case of SSEH misdiagnosed as a CVA. Treatment with tissue plasminogen activator led to worsening of his condition. On a subsequent cervical spine MRI, an epidural haematoma extending from C3 to C5 was detected and treated with laminectomy and evacuation. Surgical intervention led to significant improvement from American Spinal Injury Association Scale (ASIA) B to ASIA E. Presence of clinical features such as Horner's syndrome, Brown-Sequard syndrome and the absence of cranial nerve palsies in acute hemiparesis are indicative of SSEH rather than CVA.
Collapse
Affiliation(s)
- Ravish Patel
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Aravind Kumar
- Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Kazuya Nishizawa
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Naresh Kumar
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Reilly MP, Weiss R, Askenase A, Tuite C, Soulen M, Mohler ER. Hirudin therapy during thrombolysis for venous thrombosis in heparin-induced thrombocytopenia. Vasc Med 2016. [DOI: 10.1177/1358836x0000500407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) is the most common drug-related thrombocytopenia. Thromboembolic complications occur in approximately 50% of patients with HIT and result in limb amputation and death in up to 20% and 30% respectively. Because patients with a history of HIT may require future intravenous anticoagulation but have a high-risk of thromboembolism if re-challenged with heparin, alternative therapies are necessary when further anticoagulation is indicated. The use of direct thrombin inhibitors in HIT patients who also require thrombolytic therapy offers unique challenges to anticoagulant monitoring and safety. We present a case of progressive ileofemoral deep venous thrombosis in a patient with a history of HIT in order to review the combined use of hirudin and thrombolysis in this setting.
Collapse
Affiliation(s)
- Muredach P Reilly
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Richard Weiss
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alan Askenase
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Catherine Tuite
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael Soulen
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emile R Mohler
- Departments of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
5
|
Reed GL, Houng AK, Singh S, Wang D. α2-Antiplasmin: New Insights and Opportunities for Ischemic Stroke. Semin Thromb Hemost 2016; 43:191-199. [PMID: 27472428 DOI: 10.1055/s-0036-1585077] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Thrombotic vascular occlusion is the leading cause of ischemic stroke. High blood levels of α2-antiplasmin (a2AP), an ultrafast, covalent inhibitor of plasmin, have been linked in humans to increased risk of ischemic stroke and failure of tissue plasminogen activator (tPA) therapy. Consistent with these observations, a2AP neutralizes the therapeutic benefit of tPA therapy in experimental stroke. In addition, a2AP has deleterious, dose-related effects on ischemic brain injury in the absence of therapy. Experimental therapeutic inactivation of a2AP markedly reduces microvascular thrombosis, ischemic brain injury, brain swelling, brain hemorrhage, and death after thromboembolic stroke. These data provide new insights into the critical importance of a2AP in the pathogenesis of ischemic brain injury and suggest that transiently inactivating a2AP may have therapeutic value in ischemic stroke.
Collapse
Affiliation(s)
- Guy L Reed
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Aiilyan K Houng
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Satish Singh
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Dong Wang
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| |
Collapse
|
6
|
Kawano T, Kajimoto K, Higashi M, Minatoya K, Toyoda K, Nagatsuka K. Aortic transgraft hemorrhage after intravenous tissue plasminogen activator therapy in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:2145-2150. [PMID: 25088170 DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The safety of intravenous recombinant tissue plasminogen activator (IV tPA) therapy for patients with an aortic aneurysm or undergoing aortic graft replacement has not been established. We evaluated the incidence, bleeding site, coagulation factors, and clinical outcomes of patients treated with IV tPA for acute stroke. METHODS Between October 2005 and May 2013, 394 ischemic stroke patients were treated in our stroke center with IV tPA. Among these patients, we investigated those who had a history of aortic aneurysm with or without aortic graft replacement before IV tPA therapy and underwent computed tomography imaging. We compared the levels of D-dimer and hemoglobin (Hb) around IV tPA therapy between the patients with and without tPA-associated periaortic bleeding. RESULTS Seven patients with a history of aortic aneurysm (3 men; mean age: 80.4 years) were examined; 3 had undergone aortic graft replacement, and 2 had experienced tPA-associated bleeding around vascular grafts. The serum D-dimer levels in those with bleeding were only slightly higher before tPA than in those without (median: 10.5 vs. 1.5 μg/mL) but were elevated 1 day after tPA (107.4 vs. 8.6 μg/mL). The Hb levels 2 days after tPA were comparable with those before tPA (11.9 vs. 11.8 g/dL) but were lower in the patients with bleeding than in those without (8.5 vs. 11.7 g/dL). Surgical intervention was not required, although 1 patient required blood transfusion. CONCLUSIONS Our analysis provides reassurance regarding the risk of IV tPA therapy in patients undergoing aortic graft replacement.
Collapse
Affiliation(s)
- Tomohiro Kawano
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Katsufumi Kajimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masahiro Higashi
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
7
|
|
8
|
Acute changes of coagulation and fibrinolysis parameters after experimental thromboembolic stroke and thrombolytic therapy. Neurosci Lett 2008; 441:39-43. [PMID: 18597942 DOI: 10.1016/j.neulet.2008.05.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/22/2008] [Accepted: 05/30/2008] [Indexed: 11/19/2022]
Abstract
Thrombolysis is the only effective pharmaceutical therapy in acute ischemic stroke in humans but has a high risk of intracerebral hemorrhage. We aimed to establish an animal model to study changes of coagulation and fibrinolytic parameters during thromboembolic ischemic stroke and thrombolysis with recombinant tissue plasminogen activator (rt-PA). We used a thromboembolic stroke model in the rat. Animals were treated with rt-PA thrombolysis (n=10) and compared with untreated (n=10), sham operated (n=10) and control animals (n=20). Coagulation parameters (APTT, PT, TT, fibrinogen, AT III, TAT) and fibrinolytic parameters (t-PA antigen concentration, t-PA activity, PAI-1 concentration, PAI activity, plasminogen, antiplasmin) were measured at two time points (2.5 and 5h after stroke induction) with a battery of commercially available test kits. We observed an (1) initiation of coagulation and inhibition of fibrinolysis by the operation procedure itself, (2) simultaneous activation of fibrinolysis and its inhibitors after stroke induction and (3) potent initiation of fibrinolysis and consumption of fibrinolysis inhibitors after rt-PA therapy of stroke. We established a model system to monitor coagulation and fibrinolysis during thrombolytic therapy of stroke in the rat. This model may be used to study the influence of these parameters on hemorrhagic stroke transformation and outcome in experimental stroke in future.
Collapse
|
9
|
Tanaka Y, Ishii H, Hiraoka M, Miyasaka N, Kuroiwa T, Hajjar KA, Nagaoka T, Duong TQ, Ohno K, Yoshida M. Efficacy of recombinant annexin 2 for fibrinolytic therapy in a rat embolic stroke model: a magnetic resonance imaging study. Brain Res 2007; 1165:135-43. [PMID: 17651708 PMCID: PMC2900767 DOI: 10.1016/j.brainres.2007.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 06/02/2007] [Accepted: 06/05/2007] [Indexed: 11/19/2022]
Abstract
Efficacy of recombinant annexin 2 (rAN II) in a rat model of embolic stroke was examined using a magnetic resonance imaging (MRI) and histology. The right middle cerebral artery of male Wistar rats was occluded by autologous clots under anesthesia. Four doses of rAN II (0.125, 0.25, 0.5 and 1.0 mg/kg, n=10 for each group) or saline (1 ml/kg, n=10) were administrated intravenously within 5 min before clot infusion. Serial changes in apparent diffusion coefficient (ADC) and relative blood flow (CBF) were measured with the use of MRI in half of the animals in each group. The remaining half of the animals in each group was evaluated for hemorrhage and final infarct size by histology at 48 h after embolization. At 3 h after embolization, lesion volumes with ADC were abnormality and CBF in the peripheral lesion was improved in groups treated with 0.25, 0.5 and 1.0 mg/kg, but not 0.125 mg/kg, of rAN II in comparison with the saline-treated group (P<0.05). Histological analyses were consistent with MRI findings. More importantly, no hemorrhagic transformation was documented in rats treated with 0.125 and 0.25 mg/kg of rAN II, whereas it was observed at higher doses. We concluded that rAN II at 0.25 mg/kg significantly reduced infarct size and improved CBF without hemorrhagic complications. rAN II is a novel compound that has the potential to be a promising fibrinolytic agent to treat embolic stroke.
Collapse
Affiliation(s)
- Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Yerkes Imaging Center, Departments of Neurology and Radiology, Emory University, Atlanta, Georgia, USA
| | - Hideto Ishii
- Department of Medical Biochemistry and Vascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Megumi Hiraoka
- Department of Medical Biochemistry and Vascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Reproductive Comprehensive Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiko Kuroiwa
- Department of Neuropathology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katherine A. Hajjar
- Department of Cell and Developmental Biology, Weill Medical College of Cornell University, New York, USA
| | - Tsukasa Nagaoka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Yerkes Imaging Center, Departments of Neurology and Radiology, Emory University, Atlanta, Georgia, USA
| | - Timothy Q. Duong
- Yerkes Imaging Center, Departments of Neurology and Radiology, Emory University, Atlanta, Georgia, USA
| | - Kikuo Ohno
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Medical Biochemistry and Vascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan
- Corresponding author. Life Science and Bioethics Research Center, Tokyo Medical and Dental University, 1-5-45, Yushima Bldg D-9, Bunkyo-ku, Tokyo 113-8519, Japan. Fax: +81 3 5803 4725. (M. Yoshida)
| |
Collapse
|
10
|
Albisetti M. Thrombolytic therapy in children. Thromb Res 2006; 118:95-105. [PMID: 16709478 DOI: 10.1016/j.thromres.2004.12.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 12/22/2004] [Accepted: 12/23/2004] [Indexed: 10/25/2022]
Abstract
Thrombolysis is increasingly considered a treatment option in newborns and children with arterial and venous thromboembolic events, or occluded central venous lines. However, no uniform recommendations are available with regard to indications, drug of choice, route of administration, and dosing regimen. Thus, several protocols are used for the different thrombolytic agents, leading to differing outcome with respect to the effectiveness of therapy and bleeding complications. This article will summarize the available information on the use of thrombolytic agents in newborns and children, focussing on the potential indications, efficacy and safety profiles, and evidence supporting dosing schedules.
Collapse
Affiliation(s)
- Manuela Albisetti
- Division of Hematology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
| |
Collapse
|
11
|
Yip L. Rational use of crotalidae polyvalent immune Fab (ovine) in the management of crotaline bite. Ann Emerg Med 2002; 39:648-50. [PMID: 12023708 DOI: 10.1067/mem.2002.124450] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
12
|
Tsikouris JP, Tsikouris AP. A review of available fibrin-specific thrombolytic agents used in acute myocardial infarction. Pharmacotherapy 2001; 21:207-17. [PMID: 11213858 DOI: 10.1592/phco.21.2.207.34103] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thrombolytic agents are a first-line therapeutic option for establishing coronary artery patency in acute myocardial infarction. Three fibrin-specific thrombolytics--alteplase, reteplase, and tenecteplase--are available in the United States and have undergone preliminary patency trials and large randomized, comparative, survival studies. Patency rates differ among them, although overall mortality benefit is similar. Because of this fact and the economic impact of the drugs, competition in this market is significant. Distinguishing features of the drugs will likely influence selection. Reteplase and tenecteplase offer ease of administration with bolus dosing. Increased fibrin specificity appears to play a significant role in separating them. Tenecteplase, the most highly fibrin specific, is associated with decreased risk of noncerebral bleeding and reduced need for blood transfusions in all patients, as well as longer survival in those with late presentation acute myocardial infarction. Current trials will reveal the role of these agents in combination with glycoprotein lIb-IIIa receptor antagonists.
Collapse
Affiliation(s)
- J P Tsikouris
- Department of Pharmacy Practice,Texas Tech University School of Pharmacy, Lubbock 79430, USA
| | | |
Collapse
|
13
|
Lip GY, Blann AD. Thrombogenesis and fibrinolysis in acute coronary syndromes. Important facets of a prothrombotic or hypercoagulable state? J Am Coll Cardiol 2000; 36:2044-6. [PMID: 11127438 DOI: 10.1016/s0735-1097(00)01028-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Abstract
Prompt treatment with thrombolytic therapy in acute myocardial infarction has been proven to reduce infarct size and mortality. However, reperfusion fails to occur in 30-50% of patients, either due to impaired epicardial artery flow or microvascular occlusion, with these patients experiencing a higher morbidity and mortality. We review the diagnosis and management of failed thrombolysis in acute myocardial infarction.
Collapse
Affiliation(s)
- A Qasim
- St. Mary's Hospital, Portsmouth, UK.
| | | | | |
Collapse
|
15
|
Affiliation(s)
- C H Davies
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK.
| | | |
Collapse
|
16
|
Woo KS, Tse KK, Mak YK, Chung HK, Tse CY. Recombinant tissue plasminogen activator in acute myocardial infarction in the Chinese in Hong Kong. Int J Cardiol 1992; 36:169-76. [PMID: 1512055 DOI: 10.1016/0167-5273(92)90004-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue plasminogen activator (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 h after onset, and intravenous heparin or dipyridamole therapy started at 3 h, were studied prospectively. Their mean age was 59.6 +/- 10.6 yr. Forty-six patients (51.7%) had anterior and 39 patients (43.8%) had inferior infarcts. Clinical evidence of reperfusion were seen in 63 patients (70.8%), while new complications included hypotension (5.6%), heart failure (6.7%), cardiac arrhythmias (76.4%) majority of which are related to reperfusion and self-remitting, haematoma around vascular access sites (23.6%), melaena (3.3%) and cerebral infarction (2.2%). Maximal changes in coagulation profiles were seen at 3 h, including a decrease in fibrinogen by 64.2% and an increase in fibrin degradation products by 47 times. The changes in haemostatic variables were not related to body weight or bleeding complications. Nine patients (10.1%) had recurrence of angina and 6 patients (6.9%) died due to pump failure and reinfarction. Angiogram at 14 days confirmed TIMI 2 or 3 patency of infarct-related arteries in 63 out of 73 (86.3%) patients, with a mean global ejection fraction of 52.5 +/- 12.4%. Nearly all survivors could maintain class I-II functional status after discharge. The safety and promise of recombinant tissue plasminogen activator for acute myocardial infarction in the Chinese were confirmed.
Collapse
Affiliation(s)
- K S Woo
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong
| | | | | | | | | |
Collapse
|
17
|
Fareed J, Bacher P, Messmore HL, Walenga JM, Hoppensteadt DA, Strano A, Pifarre R. Pharmacological modulation of fibrinolysis by antithrombotic and cardiovascular drugs. Prog Cardiovasc Dis 1992; 34:379-98. [PMID: 1579631 DOI: 10.1016/0033-0620(92)90006-l] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, IL 60153
| | | | | | | | | | | | | |
Collapse
|