Role of heparin after intravenous thrombolytic therapy for acute myocardial infarction |
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| Authors: | K Kaplan R Davison M Parker B Mayberry P Feiereisel M Salinger |
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| Affiliation: | 1. From the Section of Cardiology, Department of Medicine, Northwestern University Medical School USA;2. From the Department of Nursing, Northwestern Memorial Hospital, Chicago, Illinois, USA;1. Bodegas Roda, Avda. Vizcaya, 5. Barrio de la Estación, 26200 Haro, La Rioja, Spain;2. Dpto. Prod. Agraria, Universidad Pública de Navarra, Campus Arrosadia 31006 Pamplona, Navarra, Spain;3. ICVV—Instituto de las Ciencias de la Vid y del Vno (Universidad de La Rioja, CSIC, Gobierno de La Rioja), Logroño, La Rioja, Spain;4. Grupo de Biología de las Plantas en Condiciones Mediterráneas, Departamento de Biología, Universidad de las Islas Baleares, Carretera de Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain;1. Wharton School and the Drexel University College of Medicine, University of Pennsylvania, Wynnewood, Pennsylvania;2. Weill Cornell Medical College, New York, New York;3. University of Rochester School of Medicine and Dentistry, Rochester, New York;4. University of East Anglia and Norfolk & Norwich University Hospital, Norfolk, United Kingdom;5. Emory University, Atlanta, Georgia;6. Iwate Medical University School of Medicine, Morioka, Japan;7. University of British Columbia, Vancouver, British Columbia, Canada;8. Canberra Imaging Group, Canberra, Australia;9. American College of Radiology, Reston, Virginia;10. Universidad de València, València, Spain;11. Mainz University, Mainz, Germany;12. Hôpital Bichat, Paris, France;1. National Wine and Grape Industry Centre, Charles Sturt University, Locked Bag 588, Wagga Wagga, NSW 2678, Australia;2. The Australian Research Council Training Centre for Innovative Wine Production, University of Adelaide, PMB 1, Glen Osmond, Adelaide, SA 5064, Australia;3. CSIRO Agriculture and Food, Locked Bag 2, Glen Osmond, Adelaide, SA 5064, Australia;4. School of Agricultural and Wine Sciences, Charles Sturt University, Locked Bag 588, Wagga Wagga, NSW 2678, Australia;5. NSW Department of Primary Industries, Wagga Wagga, NSW 2678, Australia;1. College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo 315100, China;2. Ningbo City College of Vocational Technology, Ningbo 315502, China;3. Institute of Crop Science and Zhejiang Key Laboratory of Crop Germplasm, Zhejiang University, Hangzhou 310058, China;1. RD-Néphrologie, Montpellier, France;2. BC2M, Univ Montpellier, Montpellier, France;3. INSERM U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France;4. Université Toulouse III Paul-Sabatier, Toulouse, France;5. BIOCRATES Life Sciences AG, Innsbruck, Austria;6. Mosaiques Diagnostics & Therapeutics AG, Hannover, Germany;7. Research Group for Clinical Bioinformatics, Institute for Electrical and Biomedical Engineering, UMIT–Private University for Health Sciences, Medical Informatics and Technology, Hall/Tirol, Austria;8. sAnalytiCo Ltd, Belfast, UK;9. Néphrologie Dialyse St Guilhem, Sète, France;10. Service de Néphrologie, Dialyse et Transplantation, CHU Montpellier, Montpellier, France |
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| Abstract: | ![]()
The optimal approach to management of patients after thrombolytic therapy for acute myocardial infarction (AMI) is unclear. The role of anticoagulation with heparin was evaluated in 75 consecutive patients who received intravenous streptokinase for AMI. Heparin therapy was titrated to keep the partial thromboplastin time (PTT) between 90 and 120 seconds. Seventeen episodes of definite myocardial ischemia (associated with reversible electrocardiographic changes) were observed in 13 patients. When episodes of probable myocardial ischemia are included (typical chest pain relieved by nitroglycerin or associated with more than a 15-mm Hg change in blood pressure but without electrocardiographic changes), 52 episodes occurred in 28 patients. Four episodes of definite and 4 of probable myocardial ischemia occurred within 24 hours of discontinuation of heparin. Analysis of the level of anticoagulation as assessed by PTT at the time of the ischemic events shows that ischemia occurred more often at lower PTTs. Nine hemorrhagic complications occurred, all within 24 hours of streptokinase infusion. In 4 patients bleeding was believed to be major and heparin administration was discontinued; 2 patients with gastrointestinal bleeding required blood transfusions. Our data suggest that after thrombolytic therapy for AMI, the level of anticoagulation is inversely related to the frequency of recurrent ischemic events; that discontinuation of heparin is frequently associated with ischemia; and that administration of heparin is associated with a low incidence of hemorrhagic complications. |
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