Improved infarct-related arterial patency after high dose, weight-adjusted, rapid infusion of tissue-type plasminogen activator in myocardial infarction: results of a multicenter randomized trial of two dosage regimens.

To determine whether a weight-adjusted high dose (2 mg/kg body weight over 3 h) rapid infusion of recombinant tissue-type plasminogen activator (rt-PA) was more efficacious than a weight-adjusted standard dose (1.25 mg/kg over 3 h) in achieving reperfusion in the setting of acute myocardial infarction, 175 patients were entered into a randomized multicenter trial. Eighty-four patients were entered into the high dose group, receiving 1.2 mg/kg (10% given as a bolus injection) over 1 h, followed by 0.8 mg/kg over the next 2 h. Ninety-one patients were given 0.75 mg/kg (10% given as a bolus injection) in 1 h, followed by 0.5 mg/kg administered over the next 2 h. The median dose in the group that received 2 mg/kg dose was 145 mg, compared with 100 mg in the group that received 1.25 mg/kg. The 90 min patency rate in the group that received 2 mg/kg was 84% compared with 70% in the group that received 1.25 mg/kg (p = 0.003). Sixty-four percent of the patients in each group underwent coronary angioplasty at the time of cardiac catheterization. The infarct-related artery patency rate at the end of catheterization was 91% in the group that received 2 mg/kg compared with 83% in the group that received 1.25 mg/kg (p = 0.08). Among patients with a patent infarct-related coronary artery after catheterization, the 6 month mortality rate in the group that received 2 mg/kg was 2.9% compared with 9.8% in the group that received 1.25 mg/kg (p = 0.15). The bleeding complication rate in the two groups was similar.(ABSTRACT TRUNCATED AT 250 WORDS)
AuthorsR W Smalling, R Schumacher, D Morris, K Harder, F Fuentes, R P Valentine, L L Battey Jr, M Merhige, D E Pitts, H A Lieberman
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 15 Issue 5 Pg. 915-21 (Apr 1990) ISSN: 0735-1097 [Print] UNITED STATES
PMID2107237 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)
Chemical References
  • Tissue Plasminogen Activator
  • Adult
  • Aged
  • Angioplasty, Balloon, Coronary
  • Blood Coagulation (drug effects)
  • Cerebral Hemorrhage (chemically induced, radiography)
  • Coronary Angiography
  • Drug Administration Schedule
  • Female
  • Hemorrhage (chemically induced)
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Myocardial Infarction (drug therapy, mortality, radiography)
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Survival Rate
  • Tissue Plasminogen Activator (administration & dosage, adverse effects)
  • Vascular Patency (drug effects)

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