A randomized controlled trial of intravenous tissue plasminogen activator and early intravenous heparin in acute myocardial infarction.
A randomized controlled trial of intravenous tissue plasminogen activator and early intravenous heparin in acute myocardial infarction.
复制标题
静脉注射组织纤溶酶原激活剂和早期静脉注射肝素治疗急性心肌梗死的随机对照试验。
DOI：
10.1161/01.cir.79.2.281
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发表时间：
1989
期刊：
影响因子：
37.8
通讯作者：
Lee,KL
中科院分区：
文献类型：
--
作者：
Topol,EJ;George,BS;Kereiakes,DJ;Stump,DC;Candela,RJ;Abbottsmith,CW;Aronson,L;Pickel,A;Boswick,JM;Lee,KL
为了评价组织型纤溶酶原激活剂（t-PA）和早期静脉注射肝素的冠状动脉溶栓效果，我们将134例急性心肌梗死患者随机分配到联合治疗组或仅使用t-PA治疗组。在症状出现后的中位数2.78小时，64名患者同时接受了t-PA （1.5 mg/kg/4小时）和10000单位肝素的注射，而70名患者接受了相同剂量的t-PA单独治疗。所有患者在治疗开始后90分钟接受冠状动脉造影以确定梗死血管通畅状态，之后对照组患者接受肝素治疗。两组的基线人口统计学和血管造影特征相似。t-PA联合肝素组梗死血管通畅率为50 / 63(79%)，单独t-PA组为54 / 68（79%）。输血需求反映的出血并发症在两组中相似：接受t-PA和肝素治疗的患者为13%，而仅接受t-PA治疗的患者为18% （p = 0.53）。该试验中唯一的颅内出血发生在一名最初不使用肝素治疗的患者身上。治疗后50分钟，接受t-PA和肝素治疗的患者纤维蛋白原较基线下降32%，而对照组下降39%。两组患者出院前左室射血分数相似：联合治疗组49.0 +/- 10.1%，单独治疗组50.2 +/- 11.9%。我们得出结论，早期静脉注射肝素不能促进t-PA在试验剂量下的纤溶作用。（摘要删节250字）
To evaluate the coronary thrombolytic efficacy of tissue plasminogen activator (t-PA) and early intravenous heparin, 134 patients with acute myocardial infarction were randomly assigned to combination therapy or t-PA only. At a median of 2.78 hours from symptom onset, 64 patients received both t-PA (1.5 mg/kg/4 hr) and a bolus of 10,000 units heparin, whereas 70 patients received t-PA alone at the same dose. All patients underwent coronary angiography 90 minutes after initiation of therapy to determine infarct vessel patency status, after which time the control group patients were eligible to receive heparin. Baseline demographic and angiographic characteristics were similar for the groups. Infarct vessel patency was 50 of 63 (79%) for combination t-PA and heparin and 54 of 68 (79%) for t-PA alone. Bleeding complications, as reflected by need for transfusion, were similar in the two groups: 13% in the patients treated with t-PA and heparin compared with 18% in patients treated with t-PA only (p = 0.53). The only intracranial hemorrhage in the trial occurred in a patient initially treated without heparin. Fibrinogen at 50 minutes after therapy was 32% decreased from baseline for the t-PA and heparin-treated patients compared with a 39% decrease in the control group. Predischarge left ventricular ejection fraction was similar for the two groups: 49.0 +/- 10.1% versus 50.2 +/- 11.9% for combined versus t-PA only therapy, respectively. We conclude that early intravenous heparin does not facilitate the fibrinolytic effect of t-PA at the doses tested.(ABSTRACT TRUNCATED AT 250 WORDS)