Conjunctive antithrombotic and thrombolytic therapy for coronary-artery occlusion

Article Abstract:

Acute myocardial infarction, popularly known as a heart attack, is the net result of a series of events. The stage is set with the slow development of atherosclerotic plaques in the walls of the coronary arteries, which supply the heart muscle with blood. A sudden rupture of the plaque can stimulate the adhesion and aggregation of platelets. The aggregated platelets then set off a series of events that leads to the coagulation of blood. The resulting clot, or thrombus, then blocks the artery. First ischemia occurs; oxygen starvation is due to the interruption in normal blood flow. If the interruption in blood flow is sufficient, the deprived area of heart muscle will infarct, or die, and permanent heart damage occurs. It seems logical to attempt to treat a heart attack with thrombolytic enzymes, agents that can dissolve blood clots. But given the complexity of the events involved, it is not surprising that all the desired effects can not be achieved with a single drug. In the November 22, 1990 issue of The New England Journal of Medicine, Hsia et al. report on their assessment of adding antithrombic (clot-inhibiting) drugs to thrombolytic treatment. Great success has been achieved using thrombolytic enzymes, such as streptokinase or tissue plasminogen activator, to re-open blocked coronary arteries. However, even after the clot is dissolved and the artery is re-opened, there remains a ruptured plaque, some aggregated platelets, and a damaged arterial wall, all of which contribute to the likelihood that a new thrombus will form. Researchers found that heparin, an inhibitor of coagulation, is more effective in keeping arteries open than aspirin, another substance with clot-inhibiting properties. The method of thrombolytic treatment for acute heart attacks has already achieved great success, but much remains to be done to refine antithrombic therapy and maximize the beneficial effects for the heart attack patient while keeping risks at a minimum. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Anticoagulants (Medicine), Anticoagulants, Aspirin, Heparin, Fibrinolytic agents, Thrombolytic drugs, editorial

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Effect of intravenous streptokinase as compared with that of tissue plasminogen activator on left ventricular function after first myocardial infarction

Article Abstract:

A study was conducted comparing two thrombolytic (clot-dissolving) agents, streptokinase (an established thrombolysis therapy) and plasminogen activator (a newer therapy), as treatments for acute myocardial infarction (MI). MI occurs when the blood supply to the heart is blocked off by a clot lodged in a coronary artery. No significant difference was observed in the effectiveness of these two agents in preserving left ventricular functions when given within three hours of the onset of a first MI. Improved thrombolytic agents are important for the treatment of MI; their use can result in early discharge and decreased medical costs. If one agent is superior to another in terms of benefit to the patient, then cost is less an issue, but if two agents are similar, cost becomes a consideration.

Analysis, Infarction, Streptokinase, Cineangiography

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