Comparison of the effect of fibrin selective thrombolytic agents on the acute myocardial infarct. First clinical experience

Hippokratia 2002, 6(3):123-128

I. Voyiatzis, T. Karamitsos, P Prodromidis, I. Vayianou, S. Papachatzi, E. Kambitsi


It is widely accepted that reducing the duration of administrating the fibrin-selective thrombolytics (plasminogen activators) we can improve the thrombolysis and the patency of coronary vessels (TIMI 3) responsible for the myocardial infarction.The aim of the study was to estimate the efficacy and safety of plasminogen activators as thrombolytic therapy in acute myocardial infarction.Seventy patients (54 men – 16 women, aged 58.13 + 10.92 years) with acute myocardial infarction were randomly assigned within 8 hours after the onset of their symptoms to receive reteplase (35 patients, 28 men – 7 women, aged 56.03 + 11.28 years), in 2 bolus doses of 10 U each given 30 min apart, or accelerated alteplase (35 patients, 26 men – 9 women, aged 60.23 + 10.28 years), up to 100 mg infused over a period of 90 min. We studied the epidemiological and clinical characteristics, biochemical markers, the left ventricular systolic function (ejection fraction) and complications. We also estimated the patency of coronary vessel, responsible for the myocardial infarction and mortality rate at 30 days follow up.The mortality rate at 30 days was 5.76% for reteplase and 3.65% for alteplase (p=0.3 / O.R = 1.06). Complications rate was also the same (17.8% – 19.8% / p = 0.18). Ejection fraction was 47.6 + 10.76% and 46.54 + 9.84% (p = 0.5). Patency rate (TIMI 3) was 65.5% and 62.4% (p=0.5). The 2 fibrin-selective thrombolytics are efficacious agents with comparable results in safety, with similar survival results at 30 days in this trial. Reteplase can be given bolus because of its longer half life, so it is proven easier in administration.