Randomized comparison of intravenous versus intracoronary streptokinase for myocardial infarction |
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Authors: | Edwin L. Alderman Kenneth R. Jutzy Larry E. Berte Rupert G. Miller Joel P. Friedman William P. Creger Michael Eliastam |
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Affiliation: | 1. From the Cardiology, Hematology, and Biostatistics Divisions, and Emergency Medicine Department, Stanford University, Stanford, California, USA;2. The Health Care Division of the Palo Alto Medical Foundation, Palo Alto, California, USA |
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Abstract: | The efficacy of intravenous (i.v.) thrombolytic therapy has not been firmly established in comparison with the intracoronary (i.c.) route of administration. In a randomized trial of 28 patients who underwent angiography before and during i.v. and i.c. administration of Streptokinase (STK), recanalization was achieved in 73% of patients who received the drug by the i.c. route, compared with 62% of patients who received the drug by the i.v. route (difference not significant). Reopening took 28 minutes for i.c. STK and 39 minutes for i.v. STK. Patients in whom recanalization was successful using either route of administration had shorter euglobulin lysis times and lower fibrinogen levels than did patients in whom it was not successful (p < 0.05). Bleeding complications were closely correlated with heparinization after thrombolysis rather than with STK itself. These results in a limited patient series suggest that early administration of i.v. STK in the emergency department may yield recanalization rates similar to those for the i.c. route and may benefit myocardial preservation by restoring flow much earlier. |
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Keywords: | Address for reprints: Edwin L. Alderman MD Cardiology Division Stanford University Medical Center Stanford California 94305. |
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