Acute coronary reocclusion after thrombolysis with recombinant human tissue-type plasminogen activator: prevention by a maintenance infusion.
Acute coronary reocclusion after thrombolysis with recombinant human tissue-type plasminogen activator: prevention by a maintenance infusion.
复制标题
DOI：
10.1161/01.cir.73.2.347
复制
发表时间：
1986-02
期刊：
影响因子：
37.8
通讯作者：
H. Gold;R. Leinbach;H. Garabedian;Tsunehiro Yasuda;Jennifer A. Johns;ELLIOrT B. Grossbard;Igor F. Palacios;DEISIRE'COLLEN
中科院分区：
文献类型：
--
作者：
H. Gold;R. Leinbach;H. Garabedian;Tsunehiro Yasuda;Jennifer A. Johns;ELLIOrT B. Grossbard;Igor F. Palacios;DEISIRE'COLLEN
采用重组人组织型纤溶酶原激活剂（rt-PA）治疗29例急性心肌梗死患者。研究急性冠状动脉再闭塞的发生率及维持输注rt-PA的预防作用。在冠脉完全闭塞的血管造影记录后60至120分钟内，以0.4至0.75 mg/kg的速率静脉注射rt-PA。29例患者中有24例（83%）在1小时内完成再灌注，并与血浆纤维蛋白原水平降低20%相关。在第一组13例患者中，其中11例成功再灌注，尝试用肝素抗凝预防再闭塞。然而，这些患者中有5例（45%）在停止rt-PA后1小时内血管造影显示急性再闭塞。定量血管造影分析表明，急性再闭塞仅发生在残余狭窄80%或以上的患者。在残余狭窄小于80%的患者中，5例患者中有4例肝素抗凝足以维持住院期间的通畅。在第二组患者（n = 16）中，13例患者接受静脉rt-PA再灌注，其中7例显示残留狭窄80%或更大。这些患者给予肝素，另外每小时给予10mg rt-PA，持续4小时。在住院期间没有发生急性血管造影再闭塞或再闭塞的临床症状。10 - 14天重复血管造影证实7例患者中有6例持续通畅。维持输注仅导致纤维蛋白原的中度额外下降，而稳定的血浆rt-PA水平维持在750 +/- 250 ng/ml。（摘要删节250字）
Twenty-nine patients with acute myocardial infarction were treated with recombinant human tissue-type plasminogen activator (rt-PA). The incidence of acute coronary reocclusion and its prevention by a maintenance infusion of rt-PA were studied. Intravenous rt-PA was given at a rate of 0.4 to 0.75 mg/kg over 60 to 120 min after angiographic documentation of complete coronary occlusion. Reperfusion was accomplished within 1 hr in 24 of 29 patients (83%) and was associated with a decrease of the plasma fibrinogen level by 20%. In a first group of 13 patients, 11 of whom were successfully reperfused, prevention of reocclusion was attempted with heparin anticoagulation. However, acute reocclusion within 1 hr after cessation of rt-PA was demonstrated angiographically in five of these patients (45%). Quantitative angiographic analysis indicated that acute reocclusion only occurred in patients with 80% or greater residual stenosis. In patients with less than 80% residual stenosis, heparin anticoagulation was sufficient to maintain patency during the hospital stay in four of five patients. In a second group of patients (n = 16), 13 of whom underwent reperfusion with intravenous rt-PA, seven demonstrated a residual stenosis of 80% or greater. These patients were given heparin and, in addition, 10 mg of rt-PA per hour for 4 hr. None developed acute angiographic reocclusion or clinical signs of reocclusion during the hospital stay. Repeat angiography at 10 to 14 days confirmed persistent patency in six of the seven patients. The maintenance infusion resulted in only a moderate additional drop in fibrinogen, while a steady-state plasma rt-PA level of 750 +/- 250 ng/ml was maintained.(ABSTRACT TRUNCATED AT 250 WORDS)