The Use of Confidence Profiles to Assess Tissue-Type Plasminogen Activator

Abstract

In the last two-and-one-half decades, thrombolytic agents have been developed to dissolve clots from coronary arteries. One of the most recent is tissue-type plasminogen activator (t-PA). At present there are several unanswered questions about the effectiveness of t-PA and its appropriate use in the treatment of MI. It has not yet been approved by the Food and Drug Administration (FDA), recommended for Medicare coverage by the Office of Health Technology Assessment, or recommended for coverage by the Blue Cross and Blue Shield Association. On the other hand, there is evidence and a strong consensus among cardiologists that t-PA is more effective than other thrombolytic agents, including streptokinase (SK) and urokinase (UK), which are approved by the FDA, and at least one third-party payer, Blue Shield of California, has approved t-PA in centers with the necessary expertise. Researchers widely assume that t-PA by itself reduces long-term mortality from MI and are already moving to a new stage of research, in which t-PA is coupled with PTCA.