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Effectiveness and safety of a single intravenous bolus injection of tissue-type plasminogen activator in acute myocardial infarction. Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST) Investigators.

Abstract
The efficacy of multiple intravenous bolus injections of tissue-type plasminogen activator (t-PA) in inducing rapid coronary recanalization in patients with acute myocardial infarction was previously demonstrated. In this Bolus Dose-Escalation Study of Tissue-Type Plasminogen Activator (BEST), the efficacy of 3 different doses of a single rapid intravenous bolus injection of t-PA (dute-plase, Wellcome Foundation, London) in inducing coronary patency (Thrombolysis In Myocardial Infarction perfusion grade 2 or 3) in 64 patients with acute myocardial infarction presenting less than 6 hours after onset of symptoms was investigated. At 60 minutes after administration of t-PA, the infarct-related coronary artery was patent in 9 of 17 patients (53%; 95% confidence interval [CI] 28 to 77%) after 0.3 MU/kg, in 14 of 23 (61%; 95% CI 39 to 80%) after 0.45 MU/kg and in 10 of 14 (71%; 95% CI 42 to 92%) after 0.6 MU/kg. At 90 minutes after t-PA, coronary patency was present in 9 of 17 cases (53%; 95% CI 28 to 77%) after 0.3 MU/kg, in 12 of 24 (50%; 95% CI 29 to 71%) after 0.45 MU/kg and in 10 of 13 (77%; 95% CI 46 to 95%) after 0.6 MU/kg. One patient in each dose group had a silent reoccluded infarct-related artery by 24 hours, and there were 2 clinical reinfarctions before discharge. No major bleeding events were observed. There were 5 hospital deaths, all unrelated to t-PA. A single intravenous bolus injection of 0.6 MU/kg of t-PA appears to be effective in inducing rapid coronary patency and to be safe in patients with acute myocardial infarction.
AuthorsD Hackett, F Andreotti, A W Haider, C Brunelli, M Shahi, A Fussell, N Buller, R Foale, D Lipkin, S Caponnetto
JournalThe American journal of cardiology (Am J Cardiol) Vol. 69 Issue 17 Pg. 1393-8 (Jun 1 1992) ISSN: 0002-9149 [Print] UNITED STATES
PMID1590225 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Fibrinogen
  • Tissue Plasminogen Activator
Topics
  • Adult
  • Aged
  • Electrocardiography
  • Female
  • Fibrinogen (analysis)
  • Humans
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Myocardial Infarction (blood, drug therapy, physiopathology)
  • Recurrence
  • Thrombolytic Therapy (adverse effects, methods)
  • Tissue Plasminogen Activator (administration & dosage, adverse effects)
  • Vascular Patency

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