Thrombolysis with rhPro-UK 3 to 6 hours after embolic stroke in rat

Comparison of Efficacy and Safety of Recombinant Human Prourokinase and Alteplase in the Treatment of STEMI and Analysis of Influencing Factors of Efficacy

OBJECTIVE

To compare the efficacy and safety of recombinant human prourokinase (rhPro-UK) and alteplase for thrombolytic therapy in acute ST-segment elevation myocardial infarction (STEMI) and to analyze the related factors affecting efficacy.

METHODS

From January 2017 to December 2019, 100 patients diagnosed with STEMI were selected and randomly divided into the control group (n = 50) and the observation group (n = 50). Based on conventional treatments, the control group was treated with alteplase, and the observation group was treated with rhPro-UK, and both were treated for 7 days. After treatment, the vascular recanalization, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were compared. The bleeding and major adverse cardiovascular events (MACE) were recorded in both groups. According to the patient's vascular recanalization, it was divided into two subgroups: recanalization group and occlusion group. Multiple logistic regression models were used to analyze the related factors that affect the efficacy.

RESULTS

The recanalization rate of the observation group (96.00%) was higher than that of the control group (84.00%) (P < 0.05). After treatment, LVDs and LVEDD in both groups were lower than those before treatment, and LVEF was higher than that before treatment. The LVDs and LVEDD in the observation group were lower than those in the control group, and the LVEF was higher than that in the control group (P < 0.05). The incidence of bleeding in the observation group (2.00%) was lower than that in the control group (12.00%), and the incidence of MACE (4.00%) was lower than that in the control group (16.00%) (P < 0.05). Univariate analysis showed that age, smoking history, diabetes history, myocardial infarction history, infarct location, and intravenous thrombolysis time were related to the efficacy after treatment (P < 0.05). Multivariate logistic analysis showed that age, history of diabetes, vascular infarction site, and venous thrombolysis time were independent influencing factors after treatment (P < 0.05).

CONCLUSION

Both rhPro-UK and alteplase thrombolytic therapy can effectively recanalize blood vessels and improve the cardiac function of patients with STEMI. However, rhPro-UK has better effect than alteplase and is safer and worth promoting. The curative effect is related to age, diabetes history, vascular infarction site, and venous thrombolysis time.

Development and Testing of Thrombolytics in Stroke

Despite recent advances in recanalization therapy, mechanical thrombectomy will never be a treatment for every ischemic stroke because access to mechanical thrombectomy is still limited in many countries. Moreover, many ischemic strokes are caused by occlusion of cerebral arteries that cannot be reached by intra-arterial catheters. Reperfusion using thrombolytic agents will therefore remain an important therapy for hyperacute ischemic stroke. However, thrombolytic drugs have shown limited efficacy and notable hemorrhagic complication rates, leaving room for improvement. A comprehensive understanding of basic and clinical research pipelines as well as the current status of thrombolytic therapy will help facilitate the development of new thrombolytics. Compared with alteplase, an ideal thrombolytic agent is expected to provide faster reperfusion in more patients; prevent re-occlusions; have higher fibrin specificity for selective activation of clot-bound plasminogen to decrease bleeding complications; be retained in the blood for a longer time to minimize dosage and allow administration as a single bolus; be more resistant to inhibitors; and be less antigenic for repetitive usage. Here, we review the currently available thrombolytics, strategies for the development of new clot-dissolving substances, and the assessment of thrombolytic efficacies in vitro and in vivo.