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The Role of Tissue Plasminogen Activator in Myocardial Infarction

  • Eric J. Topol
  • Robert M. Califf
Part of the Acute Coronary Care Updates book series (ACCU, volume 2)

Abstract

Although intravenous streptokinase has been available for over 25 years, the demonstration that emergency coronary arteriography is feasible during myocardial infarction has led to a resurgence of enthusiasm for thrombolytic therapy. In the 7 years since the documentation of the importance of thrombosis in myocardial infarction by DeWood et al (1), therapy has evolved from intracoronary streptokinase to intravenous streptokinase to intravenous clot-selective agents, including recombinant tissue-type plasminogen activator (t-PA). In this chapter, we will review the properties of t-PA as they relate to the enzyme’s clinical efficacy in acute myocardial infarction, adverse effects, and prospects for future use.

Keywords

Acute Myocardial Infarction Thrombolytic Therapy Tissue Plasminogen Activator Intravenous Streptokinase Intracoronary Streptokinase 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT: Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 303: 897–902, 1980.PubMedCrossRefGoogle Scholar
  2. 2.
    Collen D: Systemic thrombolytic therapy of acute myocardial infarction? Circulation 68:462–465, 1983.PubMedCrossRefGoogle Scholar
  3. 3.
    Burket MW, Smith MR, Walsh TE, Brewster PS, Fraker TD: Relation of effectiveness of intracoronary thrombolysis in acute myocardial infarction to systemic thrombolytic state. Am J Cardiol 56: 441–444, 1985.PubMedCrossRefGoogle Scholar
  4. 4.
    Sobel BE, Gross RW, Robison AK: Thrombolysis, clot selectivity, and kinetics. Circulation 70:160–164, 1984.PubMedCrossRefGoogle Scholar
  5. 5.
    Collen D, Topol EJ, Tiefenbrunn AJ, Gold HK, Weisfeldt ML, Sobel BE, Leinbach RC, Brinker JA, Ludbrook PA, Yasuda I, Bulkley BH, Robison AK, Hutter AM, Bell WR, Spadaro JJ, Khaw BA, Grossbard EB: Coronary thrombolysis with recombinant human tissue-type plasminogen activator: a prospective, randomized, placebo-controlled trial. Circulation 70:1012–1017, 1984.PubMedCrossRefGoogle Scholar
  6. 6.
    Tiefenbrunn AJ, Robison AK, Kurnik PB, Ludbrook PA, Sobel BE: Clinical pharmacology in patients with evolving myocardial infarction of tissue-type plasminogen activator produced by recombinant DNA technology. Circulation 71:110–116, 1985.PubMedCrossRefGoogle Scholar
  7. 7.
    Topol EJ, Bell WR, Weisfeldt ML: Coronary thrombolysis with recombinant tissue-type plasminogen activator: hematologic and pharmacologic study. Ann Int Med 103:837–843, 1985.PubMedGoogle Scholar
  8. 8.
    Hamsten A, Wiman B, deFaire U, Blomback M: Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 313:1557–1563, 1985.PubMedCrossRefGoogle Scholar
  9. 9.
    Williams DO, Borer J, Braunwald E, Chesebro JH, Cohen LS, Dalen J, Dodge HT, Francis CK, Knatterud G, Ludbrook P, Markis JE, Mueller H, Desvigne-Nickens P, Passamani ER, Powers ER, Rao AK, Roberts R, Ross A, Ryan TJ, Sobel BE, Winniford M, Zaret B: Intravenous recombinant tissue-type plasminogen activator in patients with acute myocardial infarction: a report from the NHLBI thrombolysis in myocardial infarction trial. Circulation 73(2):338–346, 1986.PubMedCrossRefGoogle Scholar
  10. 10.
    Verstraete M, Bory M, Collen D, Erbel R, Lennane RJ, Mathey D, Michels HR, Schartl M, Uebis R, Bernard R, Brower RW, de Bono DP, Huhmann W, Lubsen J, Meyer J, Rutsch W, Schmidt W, von Essen R: Randomized trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Lancet I:842–847, 1985.CrossRefGoogle Scholar
  11. 11.
    Verstraete M, Brower RW, Collen D, Dunning AJ, Lubsen J, Michel PL, Schofer JS, Vanhaecke J, Van de Werf F, Bleifeld W, Charbonnier B, de Bono DP, Lennane RJ, Mathey DG, Raynaud PH, Vahanian A, Van de Kley GA, Von Essen R: Double-blind randomized trial of intravenous tissue-type plasminogen activator versus placebo in acute myocardial infarction. Lancet II:965–969, 1985.CrossRefGoogle Scholar
  12. 12.
    The TIMI Study Group: The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 312:932–936, 1985.Google Scholar
  13. 13.
    Topol EJ, O’Neill WW, Walton JA, Bourdillon PDV, Bates ER, Langburd A, Baumann G, Burney RE, Kline E, Schork MA, Pitt B: Preliminary report of a randomized, placebo controlled trial of recombinant tissue plasminogen activator and emergency coronary angioplasty in acute myocardial infarction. Clin Res 34:349A, 1986.Google Scholar
  14. 14.
    Gold HK, Leinbach RC, Garabedian HD, Yasuda T, Johns JA, Grossbard EB, Palacios I, Collen D: Acute coronary reocclusion after thrombolysis with recombinant human tissue-type plasminogen activator: prevention by a maintenance infusion. Circulation 73(2): 347–352, 1986.PubMedCrossRefGoogle Scholar
  15. 15.
    Rentrop KP: Thrombolytic therapy in patients with acute myocardial infarction. Circulation 71:627–631, 1985.PubMedCrossRefGoogle Scholar
  16. 16.
    William DO, Borer J, Braunwald E, Chesebro JH, Cohen LS, Dalen J, Dodge HT, Francis CK, Knatterud G, Ludbrook P, Markis JE, Mueller H, Desvigna-Nickens P, Passamani ER, Powers ER, Rao AK, Roberts R, Ross A, Ryan TJ, Sobel BE, Winniford M, Zaret B and Co-investigators. Intravenous recombinant tissue-type plasminogen activator in patients with acute myocardial infarction: a report from the NHLBI thrombolysis in myocardial infarction trial. Circulation 73:338–346, 1986.CrossRefGoogle Scholar
  17. 17.
    Spann JF, Sherry S: Coronary thrombolysis for evolving myocardial infarction. Drugs 28:465–483, 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Marder VJ, Rothbard RL, Fitzpatrick PG, Francis CW, Smith EK, Rogal GJ: Dose response study of intravenous acylated streptokinase: plasmin complex (BRL26921) in coronary artery thrombosis. Circulation 70(Suppl II):II-29, 1984.Google Scholar
  19. 19.
    Van de Werf F, Nobuhara M, Collen D: Coronary thrombolysis with human sinqle-chain urokinase-type plasminogen activator (pro-urokinase) in patients with acute myocardial infarction. Ann Int Med 104:345–348, 1986.PubMedGoogle Scholar
  20. 20.
    Topol EJ, Herskowitz A, Hutchins G: Massive hemorrhagic myocardial infarction after coronary thrombolysis. Ann J Med 81:(in press), 1986.Google Scholar
  21. 21.
    Braunwald E, Kloner RA: Myocardial reperfusion: a double-edged sword? J Clin Invest 76:1713–1719, 1985.PubMedCrossRefGoogle Scholar
  22. 22.
    Gruppo Italiano Per Lo Studio Delia Streptochinasi Nell’Infarcto Miocardio (GISSI): effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet I:397–401, 1986.Google Scholar
  23. 23.
    Simoons ML, Brand M V/D, de Zwaan C, Verheugt FWA, Remme WJ, Serruys PW, Bar F, Res J, Krauss XH, Vermeer F: Improved survival after early thrombolysis in acute myocardial infarction. Lancet II:578–582, 1985.CrossRefGoogle Scholar
  24. 24.
    Nobuyoshi M, Nosaka H, Yasumoto H: Can intracoronary thrombolysis prevent free wall rupture of acute myocardial infarction? JACC 7: (2) 107A, 1986.Google Scholar
  25. 25.
    The I.S.A.M. Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (I.S.A.M): mortality, morbitidy and infarct size at 21 days. N Engl J Med 314:1465–1471, 1986.CrossRefGoogle Scholar
  26. 26.
    Schmidt WG, Essen RV, Uebis R, Effert S, Rutsch W, Schartl M, Schmutzler H, Erbel R, Meyer J: Thrombolytic treatment of acute myocardial infarction with recombinant-tissue type plasminogen activator: coronary state after 4 weeks. J Am Coll Cardiol 7:16A, 1986.Google Scholar
  27. 27.
    Krucoff MW, Green CE, Satler LF, Miller FC, Pallas RS, Kent KM, Del Negro AA, Pearle DL, Fletcher RD, Rackley CE: Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. Am J Cardiol 57:916–922, 1986.PubMedCrossRefGoogle Scholar
  28. 28.
    Kircher B, Topol EJ, Schork MA, Kline E, Pitt B, O’Neill W: Noninvasive prediction of infarct vessel recanalization status after intravenous tissue plasminogen activator or streptokinase. Clin Res 34:315A, 1986.Google Scholar
  29. 29.
    Sobel BE, Fields LE, Robison AK, Fox KAA, Sarnoff SJ: Coronary thrombolysis with facilitated absorption of intramuscularly injected tissue-type plasminogen activator. Proc Natl Acad Sci 82:4258–4262, 1985.PubMedCrossRefGoogle Scholar
  30. 30.
    Fox KAA, Robison AK, Knabb RM, Rosamond TL, Sobel BE, Bergmann SR: Prevention of coronary thrombosis with subthrombolytic doses of tissue-type plasminogen activator. Circulation 72(6):1346–1354, 1985.PubMedCrossRefGoogle Scholar
  31. 31.
    Clouse LH, Comp PC: The regulation of hemostasis: the protein C system. N Engl J Med 314:1298–1304, 1986.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1987

Authors and Affiliations

  • Eric J. Topol
  • Robert M. Califf

There are no affiliations available

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