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.

Abstract

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)

• Authors: R 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
• Journal: Journal 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
• PMID: 2107237 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Tissue Plasminogen Activator

Topics

• Adult
• Aged
• Angioplasty, Balloon, Coronary
• Blood Coagulation (drug effects)
• Cerebral Hemorrhage (chemically induced, diagnostic imaging)
• Coronary Angiography
• Drug Administration Schedule
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Multicenter Studies as Topic
• Myocardial Infarction (diagnostic imaging, drug therapy, mortality)
• Randomized Controlled Trials as Topic
• Recurrence
• Survival Rate
• Tissue Plasminogen Activator (administration & dosage, adverse effects)
• Vascular Patency (drug effects)