Author + information
- Received November 29, 1989
- Revision received February 16, 1990
- Accepted April 16, 1990
- Published online October 1, 1990.
- Gabriel I. Barbash, MD, MPH*,a,
- Hanoch Hod, MD*,
- Arie Roth, MD†,
- Hedy E. Faibel, MD‡,
- Yury Mandel, MD§,
- Hilton I. Miller, MD, FACC†,
- Shemuel Rath, MD*,
- Yedahel Har Zahav, MD*,
- Babeth Rabinowitz, MD*,
- Uri Seligsohn, MD‖,
- Benny Pelled, MD§,
- Zwi Schlesinger, MD‡,
- Michael Motro, MD, FACC*,
- Shlomo Laniado, MD, FACC† and
- Elieser Kaplinsky, MD, FACC*
- ↵aAddress for reprints: Gabriel I. Barbash, MD, MPH, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel 52621.
When conventional treatment of patients with early clinical reinfarction after thrombolytic therapy fails, mechanical revascularization may be attempted. An alternative strategy, repeat thrombolytic infusions, is reported. Fifty-two patients with acute myocardial infarction were treated with one or two additional thrombolytic infusions of recombinant tissue-type plasminogen activator (rt-PA) because of nonsustained ischemia after initial treatment with rt-PA or streptokinase. Thirty-five patients received the second infusion within 1 h of the first; 13 patients received the second infusion 1 to 72 h after the first and 4 patients received it later during their hospitalization.
Bleeding complications occurred in 10 patients (19%); however, most of these were minor (no intracranial bleeding) and only 2 patients required blood transfusion. In 14 patients in whom the decrease in fibrinogen and plasminogen levels was measured after the first and second infusions, this decrease was only 25% and 63%, respectively—only slightly higher than the 22% and 53% decreases measured in 63 patients who had only one rt-PA infusion. In 44 patients (85%), the acute ischemia resolved completely within 1 h after initiation of the second infusion. In 23 patients (44%), pain and ST segment elevation did not recur and invasive coronary intervention was avoided.
Thus, repeat rt-PA infusions can stabilize a substantial number of patients with acute reinfarction and, even when relief is temporary, repeat rt-PA infusions can minimize myocardial damage while patients await mechanical revascularization.
- Received November 29, 1989.
- Revision received February 16, 1990.
- Accepted April 16, 1990.
- American College of Cardiology Foundation