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A matched comparison of the combination of prehospital thrombolysis and standby rescue angioplasty with primary angioplasty

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期83卷 305-310页

作者： Juliard, JM Himbert, D Cristofini, P Desportes, JC Magne, M Golmard, JL Aubry, P Benamer, H Boccara, A Karrillon, GJ Steg, PG Hop Bichat Claude Bernard Serv Cardiol F-75877 Paris France Hop Necker Enfants Malad Serv Aide Med Urgente Paris France Brigade Sapeurs Pompiers Paris France Hop Beaujon Serv Med Urgence & Reanimat Clichy France Hop La Pitie Salpetriere INSERM U436 Paris France

This study sought to assess the rate of acute Thrombolysis In Myocardial Infarction (TIMI) trial grade 3 patency that can be achieved with the combination of prehospital thrombolysis and standby rescue angioplasty in acute myocardial infarction. No large angiographic study has been performed after prehospital thrombolysis to determine the 90-minute TIMI 3 potency rate in the infarct related artery. Hospital outcome and artery patency were compared to 170 matched patients treated with primary angioplasty. Prehospital thrombolysis was applied 151 +/- 61 minutes after the onset of pain in 170 patients (56 +/- 12 years, 86% men), using recombinant tissue-type plasminogen activator, streptokinase, or eminase. Emergency 90-minute angiography was performed in every case. All patients in whom thrombolysis failed underwent rescue angioplasty. After thrombolysis alone, TIMI grade 3 flow in the infarct-related artery was observed in 108 patients (64%), TIMI grade 2 in 12 (7%), and TIMI grade 0 or 1 in 50 (29%). Rescue angioplasty was successful in 47 of 50 attempts. Overall, TIMI 3 potency was achieved in 91%, and additionally TIMI 2 flow in 7% of patients, an average of 113 +/- 39 minutes after thrombolysis and 55 +/- 19 minutes after admission. Therefore, <2 hours after thrombolysis, only 2% of patients had persistent occlusion (TIMI 0 or 1) of the infarct-related artery. In-hospital mortality was 4% overall (7 of 170), and 3% in the 155 patients in whom TIMI 3 was obtained during the acute phase. Severe hemorrhagic complications occurred in 14 patients (8%) with 2 fatal cerebral hemorrhages (7% of patients required transfusions). The matched comparison with primary PTCA showed no significant difference in hospital outcome. Combined prehospital thrombolysis, 90-minute angiography, and rescue angioplasty yield a high rate of acute TIMI 3 potency rate early after thrombolysis and hospital admission. A randomized, prospective comparison between these 2 reperfusion strategies ma

关键词：血管成形术经腔经皮冠状动脉阿尼普酶/治疗应用综合疗法冠状血管造影术急救医疗服务纤维蛋白溶解药/治疗应用随访研究心肌梗死/死亡率心肌梗死/放射摄影术心肌梗死/治疗重组蛋白质类复发链激酶/治疗应用存活率血栓溶解疗法组织型纤溶酶原激活物/治疗应用治疗结果成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Myoglobin, creatine-kinase-MB and cardiac Troponin-I 60-minute ratios predict infarct-related artery patency after thrombolysis for acute myocardial infarction - Results from the Thrombolysis in Myocardial Infarction study (TIMI) 10B

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 739-747页

作者： Tanasijevic, MJ Cannon, CP Antman, EM Wybenga, DR Fischer, GA Grudzien, C Gibson, CM Winkelman, JW Braunwald, E Brigham & Womens Hosp Clin Labs Boston MA 02115 USA Brigham & Womens Hosp Dept Med Boston MA 02115 USA Vet Affairs Med Ctr Dept Med W Roxbury MA USA

OBJECTIVES We examined the diagnostic performance of serum myoglobin, creatine-kinase-MB (CKMB) and cardiac Troponin-I (cTnI) for predicting the infarct-related artery (IRA) patency in patients receiving TNK-tissue plasminogen activator (TNK-tPA) therapy for acute myocardial infarction (AMI) in the Thrombolysis in Myocardial Infarction (TIMI) 10B trial. BACKGROUND A reliable noninvasive serum marker of IRA patency is desired to permit early identification of patients with a patent IRA after thrombolysis. METHODS We measured myoglobin, CK-MB and cTnI concentrations in sera obtained just before thrombolysis (T0) and 60 min later (T60) in 442 patients given TNK-tPA and who underwent coronary angiography at 60 min. RESULTS Angiography at 60 min showed a patent IRA (TIMI flow grade 2, 3) in 344 and occluded IRA (TIMI flow grade 0, 1) in 98 patients. The median serum T60 concentration, the ratio of the T60 and TO serum concentration (60-min ratio) and the slope of increase over 60 min for each serum marker were significantly higher in patients with patent arteries compared with patients with occluded arteries. The area under the receiver-operating characteristic (ROC) curve for diagnosis of occlusion was 0.71, 0.70 and 0.71 for the 60-min ratio of myoglobin, cTnI. and CKMB, respectively. The 60-min ratios of greater than or equal to 4.0 for myoglobin, greater than or equal to 3.3 for CK-MB and greater than or equal to 2.0 for cTnI yielded a probability of patency of 90%, 88% and 87%, respectively. CONCLUSIONS The diagnostic performance of serum myoglobin, CK-MB and cardiac Tropinin-I (cTnI) 60-min ratios was similar. The probability of a patent IRA was very high (90%) in patients with 60-min myoglobin ratio greater than or equal to 4.0, and early invasive interventions to establish IRA patency may not be necessary in this group. Serum marker determinations at baseline and 60-min after thrombolysis may permit rapid triage of patients receiving thrombolytic therapy by rulin

关键词：临床酶试验/方法临床酶试验/统计学和数值数据肌酸激酶/血液同工酶类心肌梗死/诊断心肌梗死/药物疗法心肌梗死/病理生理学肌红蛋白/血液预后 ROC曲线血栓溶解疗法/方法血栓溶解疗法/统计学和数值数据时间因素组织型纤溶酶原激活物/治疗应用肌钙蛋白I/血液血管未闭/药物作用老年人女(雌)性人类男(雄)性中年人

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Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期128卷 147-154页

作者： Shiraga, F Matsuo, T Yokoe, S Takasu, I Okanouchi, T Ohtsuki, H Grossniklaus, HE Okayama Univ Sch Med Dept Ophthalmol Okayama 7008558 Japan Emory Univ Sch Med Dept Ophthalmol Atlanta GA 30322 USA

PURPOSE: To report the visual outcome of surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy, METHODS: Eight eyes of eight consecutive patients with thick submacular hemorrhages associated with idiopathic polypoidal choroidal vasculopathy were treated with pars plana vitrectomy and tissue plasminogen activator-assisted removal of subretinal blood (December 1995 to September 1997) or intravitreal 100% sulfur hexafluoride gas injection without tissue plasminogen activator (October 1997 to March 1998). RESULTS: Postoperatively, laser treatment was pere formed for active polypoidal lesions outside the foveal avascular zone in four eyes. A retinal pigment epithelial rear was seen outside the foveal avascular zone in three eyes, and one eye developed a retinal detachment. The best-corrected visual acuity improved (by 3 or more lines) or stabilized in seven of the eight eyes. Four eyes had a final best-corrected visual acuity of 20/40 or better, and three eyes had a final best-corrected visual acuity of 20/50 to 20/200. In one eye, the visual acuity decreased from 20/100 to 20/500 because of the development of a subfoveal neovascular membrane. The membrane was excised, and histologic examination showed fibrovascular: tissue between the retina and retinal pigment epithelium (type 2 pattern). CONCLUSIONS: Surgical intervention may be of benefit in eyes with submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy. (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：脉络膜/血液供给脉络膜/病理学脉络膜疾病/并发症脉络膜疾病/诊断脉络膜疾病/药物疗法脉络膜疾病/外科学纤维蛋白溶解药/治疗应用荧光素血管造影术随访研究眼底注射激光凝固术黄斑/病理学黄斑/外科学手术后并发症/诊断手术后并发症/外科学再手术视网膜视网膜出血/诊断视网膜出血/药物疗法视网膜出血/病因学视网膜出血/外科学回顾性研究硫六氟化物/治疗应用组织型纤溶酶原激活物/治疗应用玻璃体切除术玻璃体老年人女(雌)性人类男(雄)性中年人

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Triple therapy for acute myocardial infarction: Combining fibrinolysis, platelet IIb/IIIa inhibition, and percutaneous coronary intervention

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第8A期85卷 10C-16C页

作者： Herrmann, HC Univ Penn Med Ctr Philadelphia PA 19104 USA

Reperfusion for acute myocardial infarction (MI) has generally been approached in 1 of 2 ways-fibrinolysis or primary angioplasty, Although fibrinolysis is widely available and has been shown to reduce mortality and improve left ventricular function, its disadvantages include hemorrhage, failure to reperfuse in vp to 40% of patients, and early reocclusion in up to 10% of patients. Alternatively, primary angioplasty offers the advantages of anatomic definition, the potential for higher rates of reperfusion, and a lower rate of intracranial hemorrhage, Recently, a better understanding of platelet physiology and its inhibition, and advances in mechanical revascularization with stents have led to combined approaches (fibrinolytic agents, glycoprotein IIb/IIIa inhibitors, and percutaneous coronary interventions [PCI]), Faciliated PCI, the use of planned PCI after pharmacologic reperfusion therapy, has the best potential to fuse the best aspects of thrombolysis and primary angioplasty, This article reviews recent advances and trials studying use of these combinations, (C) 2000 by Excerpta Medico, Inc.

关键词：抗体单克隆/治疗应用纤维蛋白溶解药/治疗应用免疫球蛋白Fab片段/治疗应用心肌梗死/药物疗法心肌梗死/治疗血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂随机对照试验(主题) 支架组织型纤溶酶原激活物/治疗应用人类

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Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement

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OPHTHALMOLOGY 1999年第10期106卷 1900-1906页

作者： Hassan, AS Johnson, MW Schneiderman, TE Regillo, CD Tornambe, PE Poliner, LS Blodi, BA Elner, SG Univ Michigan WK Kellogg Eye Ctr Dept Ophthalmol Sch Med Ann Arbor MI 48105 USA Pacific Eye Care Poulsbo WA USA Wills Eye Hosp Retina Serv Philadelphia PA USA Retina Consultants San Diego CA USA Univ Wisconsin Dept Ophthalmol Madison WI 53706 USA

Objective: To investigate the efficacy and safety of treating thick submacular hemorrhages with intravitreous tissue plasminogen activator (tPA) and pneumatic displacement. Design: Retrospective, noncomparative case series. Participants: From 5 participating centers, 15 eligible patients had acute (<3 weeks) thick subretinal hemorrhage involving the center of the macula in eyes with pre-existing good visual acuity. Hemorrhages were secondary to age-related macular degeneration in 13 eyes and macroaneurysm and trauma in 1 eye each. Methods: The authors reviewed the medical records of 15 consecutive patients who received intravitreous injection of commercial tPA solution (25-100 mu g in 0.1-0.2 ml) and expansile gas (0.3-0.4 ml of perfluoropropane or sulfur hexafluoride) for thrombolysis and displacement of submacular hemorrhage. After surgery, patients maintained prone positioning for 1 to 5 days (typically, 24 hours). Main Outcome Measures: Degree of blood displacement from under the fovea, best postoperative visual acuity, final postoperative visual acuity, and surgical complications. Results: In 15 (100%) of 15 eyes, the procedure resulted in complete displacement of thick submacular hemorrhage out of the foveal area. Best postprocedure visual acuity improved by 2 lines or greater in 14 (93%) of 15 eyes. After a mean follow-up of 10.5 months (range, 4-19 months), final visual acuity improved by 2 lines or greater in 10 (67%) of 15 eyes and measured 20/80 or better in 6 (40%) of 15 eyes. Complications included breakthrough vitreous hemorrhage in three eyes and endophthalmitis in one eye. Four eyes developed recurrent hemorrhage 1 to 3 months after treatment, three of which were retreated with the same procedure. Conclusions: Intravitreous injection of tPA and gas followed by brief prone positioning is effective in displacing thick submacular blood and facilitating visual improvement in most patients. The rate of serious complications appears low. Final visual outco

关键词：动脉瘤/并发症眼损伤/并发症纤维蛋白溶解药/治疗应用氟碳化合物/治疗应用注射黄斑黄斑变性/并发症手术后并发症俯卧位视网膜出血/药物疗法视网膜出血/病因学视网膜血管/病理学回顾性研究硫六氟化物/治疗应用血栓溶解疗法组织型纤溶酶原激活物/治疗应用治疗结果视敏度玻璃体青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Comparative fibrinolytic activity of front-loaded alteplase and the single-bolus mutants tenecteplase and lanoteplase during treatment of acute myocardial infarction

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AMERICAN HEART JOURNAL 2003年第2期145卷 217-225页

作者： Al-Shwaft, KA de Meester, A Pirenne, B Col, JJ Catholic Univ Louvain Hop St Luc Div Cardiol Dept Internal Med Haine St Paul Belgium Hop Jolimont Div Cardiol Dept Internal Med Haine St Paul Belgium Hop St Pierre Dept Intens Med Ottignies Belgium

Background Quantification of fibrinolytic activity (FAct) in clinical practice has been abandoned because of the complexity of existing assays. The relationship between thrombolytic drug concentration and FAct is complex. FAct profiles of currently used thrombolytic drugs were not characterized. Methods By use of a system that quantifies FAct by shortening of clot lysis onset time (LOT), we measured LOT in vitro with incremented concentrations of alteplase (t-PA) and tenecteplase (TNK-tPA) and ex vivo in patients with acute myocardial infarction who were receiving front-loaded t-PA (n = 3 1), 30 to 40 mg TNK-tPA (n = 19), and 120 kU/kg lanoteplase ([n-PA] n = 23). Results In vitro, FAct depended on drug concentration by means of a double exponential model revealing 2 distinct activity zones (weak/strong). Ex vivo, no FAct was detected before agent administration (LOT > 1200 seconds). Ten minutes after a bolus was given, FAct was sharply increased in all patients, but it increased more with TNK-tPA than with t-PA or n-PA (mean LOT of 109, 125, and 130 seconds, respectively, P < .05). At 90 minutes, accelerated infusion of t-PA resulted in FAct that remained stronger than that observed for TNK-tPA (P < .0001) or n-PA (P = .011). At 180-minutes, significant FAct (LOT <600 seconds) was only observed in patients who received n-PA. Conclusion This study provides the first direct comparison of FAct between t-PA, TNK-tPA, and n-PA by use of the LOT test, the results of which are reliably related to drug concentration. The ideal FAct profile would combine an immediate strong FAct of relatively short duration, as seen with TNK-tPA, that may contribute to its better efficacy/safety profile in the Assessment of Safety and Efficacy of a New Thrombolytic Agent-2 (ASSENT-2) trial. Prolonged FAct after n-PA may contribute to increased hemorrhagic complications, as seen in the Intravenous n-PA for Treatment of Infarcting Myocardium Early-2 (InTIME-2) trial. Thus, characterizing FAct

关键词：纤维蛋白溶解/药物作用纤维蛋白溶解药/治疗应用心肌梗死/血液心肌梗死/药物疗法血栓溶解疗法/方法时间因素组织型纤溶酶原激活物/治疗应用老年人女(雌)性人类男(雄)性中年人

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Intraclot recombinant tissue plasminogen activator in the treatment of deep venous thrombosis of the lower and upper extremities

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AMERICAN JOURNAL OF MEDICINE 2000年第3期108卷 251-255页

作者： Horne, MK Mayo, DJ Cannon, RO Chen, CC Shawker, TH Chang, R NHLBI Warren G Magnuson Clin Ctr Dept Clin Pathol NIH Bethesda MD 20892 USA NHLBI Warren G Magnuson Clin Ctr Dept Nucl Med NIH Bethesda MD 20892 USA NHLBI Warren G Magnuson Clin Ctr Dept Diagnost Radiol NIH Bethesda MD 20892 USA NHLBI Cardiol Branch NIH Bethesda MD 20892 USA

Anticoagulation treats the acute symptoms of deep venous thrombosis and reduces the risk of pulmonary emboli. It is less effective, however, in preventing chronic sequellae (1). These are caused by permanent damage to venous valves, which may be reduced by treatment with thrombolytic agents (2–4). The most commonly used drug for this purpose has been urokinase (Abbokinase, Abbott Laboratories, Abbott Park, Illinois), which is usually infused directly into the thrombi (5). However, the supply of urokinase has become very limited because its production was suspended after the Food and Drug Administration discovered manufacturing deficiencies (6,7).

关键词：臂纤维蛋白溶解药/治疗应用腿静脉造影术重组蛋白质类/治疗应用回顾性研究组织型纤溶酶原激活物/治疗应用治疗结果静脉血栓形成/药物疗法静脉血栓形成/放射摄影术成年人老年人女(雌)性人类男(雄)性中年人

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Tissue plasminogen activator and gas for diabetic premacular hemorrhage

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第3期129卷 393-394页

作者： Yang, CM Chen, MS Natl Taiwan Univ Hosp Dept Ophthalmol Taipei Taiwan

PURPOSE: To report the effect of intravitreal injection of tissue plasminogen activator and gas for the treatment of diabetic premacular hemorrhage. METHODS: Five eyes of five consecutive patients with fresh diabetic premacular hemorrhage and previous panretinal photocoagulation were treated with intravitreal injection of 50 mu g of tissue plasminogen activator, and 0.3 mi of sulfur hexafluoride, After intravitreal injection, patients maintained a prone position for 3 days and were followed for an average of 7 months (range, 6 to 8 months), RESULTS: All eyes had clearing of the premacular hemorrhage with improved visual acuity. Three eyes with no visible fibrovascular proliferation required 3 weeks to resorb the hemorrhage, and two eyes with active fibrovascular proliferation needed 2 months to resorb the intravitreal hemorrhage, CONCLUSION: Intravitreal injection of tissue plasminogen activator and gas may be an effective way to treat fresh diabetic premacular hemorrhage (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：糖尿病视网膜病变/并发症糖尿病视网膜病变/药物疗法纤维蛋白溶解纤维蛋白溶解药/治疗应用注射俯卧位视网膜出血/并发症视网膜出血/药物疗法视网膜新生血管化/病因学视网膜新生血管化/预防和控制硫六氟化物/治疗应用组织型纤溶酶原激活物/治疗应用治疗结果视敏度成年人人类中年人

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Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery

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MICROSURGERY 1999年第6期19卷 265-271页

作者： Atiyeh, BS Hashim, HA Hamdan, AM Musharafieh, RS American Univ Beirut Med Ctr Div Plast & Reconstruct Surg Beirut Lebanon

Vascular thrombosis remains a dreaded complication of any microvascular procedure, be it composite tissue transfer or replantation of amputated limbs or parts. Despite the tremendous advances in microvascular-related technologies and the accumulated surgical skills, failures caused by occlusion of anastomosed vessels remain a continuous source of frustration to all microsurgeons alike, Several anticoagulation and antiplatelet protocols have been proposed to be used in conjunction with microvascular surgery. More recently, thrombolytic drugs such as urokinase, streptokinase, and thrombolysin have been introduced, yet their systemic effect on hemostasis remains an undesirable side effect, We present our experience with local intra-arterial, intravenous, and soft-tissue injection of recombinant tissue plasminogen activator rt-PA in replantation surgery in three consecutive patients. Arterial thrombi are managed by intra-arterial rt-PA infusion with the catheter placed proximal to the arterial anastomosis. Venous thrombi are best lysed by infusing rt-PA in an engorged vein of the replanted limb. In replanted digits, direct intravenous infusion is not possible, In such situations, injection of rt-PA in the pulp soft tissues may result in successful salvage. We believe this agent also has a role in microvascular composite tissue transfer in preventing free flap failures as well as in salvaging failing flaps. (C) 1999 Wiley-Liss, Inc.

关键词：截肢创伤性/外科学纤维蛋白溶解药/投药和剂量纤维蛋白溶解药/治疗应用指/外科学前臂/外科学移植物闭塞血管/预防和控制再植术/方法血栓溶解疗法组织型纤溶酶原激活物/投药和剂量组织型纤溶酶原激活物/治疗应用青少年成年人儿童学龄前人类男(雄)性

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THE INTRINSIC LYSIS CONCEPT

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 1992年第1期667卷 224-232页

作者： GUREWICH, V LIU, JN PANNELL, R Vascular Research Laboratory Burlington Building-Rm 545 S Institute for the Prevention of Cardiovascular Disease New England Deaconess Hospital Harvard Medical School 185 Pilgrim Food Boston Massachusetts 02215

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