Back to the future: so what will fibrinolytic therapy offer your patients with myocardial infarction?

Functional identification of t-PA in crude and purified systems

In the present study the activation of glu-plasminogen by fibrin-bound t-PA was determined by integrating spectrophotometric and computer analysis of the reaction. Our aim was to determine the parameters of the activation and to characterize the functional activity of t-PA. Our results indicate that the t-PA present in purified or crude sources such as plasma or culture supernatants, can be specifically identified using the methodology described in this report.

Achievement of coronary artery patency by use of anisoylated plasminogen streptokinase activator complex in acute myocardial infarction

Anisoylated plasminogen streptokinase activator complex (APSAC) is a recently developed thrombolytic agent with high fibrin-binding potential and sustained release pharmacokinetics (plasma half-life 70 minutes). Following studies of its intracoronary use, the efficacy was examined, in an open study using coronary angiography, of a single bolus dose of 30U given intravenously to 94 patients within 6 hours (mean 2.97 hours) from the onset of symptoms of myocardial infarction. After thrombolytic therapy, patency of the left anterior descending artery was demonstrated in 32 of 42 patients with anterior infarctions (76%), and in 12 of 13 patients with circumflex (92%) and 28 of 36 with right coronary artery infarcts (78%) in the inferior infarction group. The overall incidence of reocclusion was 24%, which occurred within the first 12 days after hospitalisation. Successful thrombolysis was associated with rapid resolution of the acute ST segment change, and an early peak of creatine phosphokinase (CK) compared with patients whose vessels remained occluded. No major systemic bleeding complications were experienced. Single dose intravenous APSAC appears to be a highly effective and relatively safe thrombolytic agent which has the major advantage over other such agents of easier administration. This makes it suitable for use in district hospitals and in the community, as well as in specialised cardiac centres.