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Titolo:
ALTEPLASE - A REAPPRAISAL OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC USE IN ACUTE MYOCARDIAL-INFARCTION
Autore:
GILLIS JC; WAGSTAFF AJ; GOA KL;
Indirizzi:
ADIS INT LTD,41 CENTORIAN DR,PRIVATE BAG 65901,MAIRANGI BAY AUCKLAND 10 NEW ZEALAND
Titolo Testata:
Drugs
fascicolo: 1, volume: 50, anno: 1995,
pagine: 102 - 136
SICI:
0012-6667(1995)50:1<102:A-AROI>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
TISSUE-PLASMINOGEN-ACTIVATOR; LEFT-VENTRICULAR FUNCTION; COMBINATION THROMBOLYTIC THERAPY; CORONARY-ARTERY REPERFUSION; REGIONAL WALL MOTION; INTRAVENOUS RT-PA; RANDOMIZED TRIAL; IMMEDIATE ANGIOPLASTY; PREHOSPITAL THROMBOLYSIS; THROMBIN GENERATION;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
157
Recensione:
Indirizzi per estratti:
Citazione:
J.C. Gillis et al., "ALTEPLASE - A REAPPRAISAL OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC USE IN ACUTE MYOCARDIAL-INFARCTION", Drugs, 50(1), 1995, pp. 102-136

Abstract

Alteplase (recombinant tissue-type plasminogen activator) stimulates the fibri inolysis of blood clots by converting plasminogen to plasmin. The efficacy of intravenous alteplase in the early treatment of patients with acute myocardial infarction has been unequivocally proven, and recent results from the GUSTO trial indicate a significant advantage in 30-day survival for alteplase in an accelerated dosage regimen (less than or equal to 100mg infused over 90 minutes rather than 3 hours) over streptokinase. The advantage of the accelerated alteplase dosage regimen seems to be maintained for at least 1 year. The role of heparin as adjunctive therapy to thrombolysis remains to be fully defined but heparin admimistration appears to be more important in conjunctionwith alteplase than with streptokinase. Ideally, patients should receive alteplase as soon as possible after the onset of symptoms of acutemyocardial infarction and, while therapy is most beneficial when administered early, survival is improved when the drug is administered up to 12 hours after symptom onset. The accelerated regimen of altephase used in the GUSTO trial demonstrated a survival advantage in patients less than or equal to 75 as well as those > 75 years of age which was at least as great as that seen with streptokinase, Similarly, alteplase reduces mortality in patients with both anterior and inferior infarctions; however those with anterior wall infarctions show an improved outcome over those with inferior infarcts. On the basis of pharmacoeconomic analysis of GUSTO data, the accelerated alteplase regimen cost anestimated additional $US32 678 per year of life saved compared with aconventional streptokinase regimen. Cumulative 1-year costs were greater in patients who received the accelerated alteplase regimen bur survival was significantly greater than in patients who received streptokinase. No difference in quality of life was evident inpatients who received either treatment. The incidence of major haemorrhage associated with alteplase therapy appears to be similar to that seen with other fibrinolytic agents, increasing with increasing dose; however the risk of stroke, particularly haemorrhagic stroke, is higher with alteplase than with streptokinase. Thus, alteplase has become firmly establishedas a first-line option in the management of acute myocardial infarction. On the basis of accumulated evidence, the greatest risk reduction with alteplase therapy may be in certain high risk groups, such as those with anterior infarcts, selected elderly patients and those who present late after symptom onset.

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Documento generato il 24/09/20 alle ore 21:24:49