Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1990 Aug;64(2):118–120. doi: 10.1136/hrt.64.2.118

Enhanced thrombolytic efficacy and reduction of infarct size by simultaneous infusion of streptokinase and heparin.

G Melandri 1, A Branzi 1, F Semprini 1, V Cervi 1, N Galiè 1, B Magnani 1
PMCID: PMC1024350  PMID: 2203397

Abstract

Because paradoxical increase in thrombin activity was reported after the administration of streptokinase in patients with acute myocardial infarction the velocity of reperfusion and degree of myocardial damage were studied when heparin was infused during rather than after streptokinase infusion. Thirty seven consecutive patients with acute myocardial infarction were randomised to receive intravenous heparin during (group 1, n = 18) or after (group 2, n = 19) streptokinase (1.5 megaunits over 60 minutes). Markers of reperfusion were monitored every 15 minutes for 3 hours. The serum concentration of creatine kinase was measured every 2 hours. The two groups were similar in terms of age and sex distribution, infarct site, time to treatment, and baseline myocardial ischaemia. Patients in group 1 had a significantly shorter mean (SD) reperfusion time (57 (35) minutes v 101 (47)). From 60 to 120 minutes after randomisation there were significant differences in ST segment elevation between the groups. Serum creatine kinase MB peaked earlier (8 (2) hours) in group 1 than in group 2 (10 (4) hours). The peak concentration was significantly lower in group 1 (87 (47) mU/ml) than in group 2 (134 (96) mU/ml) and infarcts were smaller (25.2 (9.8) gram equivalents/m2) in group 1 than in group 2 (35.1 (10.2) gram equivalents/m2). Simultaneous infusion of heparin and streptokinase speeds up the appearance of signs of reperfusion and reduces infarct size.

Full text

PDF
118

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Eisenberg P. R., Sherman L. A., Jaffe A. S. Paradoxic elevation of fibrinopeptide A after streptokinase: evidence for continued thrombosis despite intense fibrinolysis. J Am Coll Cardiol. 1987 Sep;10(3):527–529. doi: 10.1016/s0735-1097(87)80194-8. [DOI] [PubMed] [Google Scholar]
  2. Ganz W., Geft I., Maddahi J., Berman D., Charuzi Y., Shah P. K., Swan H. J. Nonsurgical reperfusion in evolving myocardial infarction. J Am Coll Cardiol. 1983 May;1(5):1247–1253. doi: 10.1016/s0735-1097(83)80136-3. [DOI] [PubMed] [Google Scholar]
  3. Ganz W., Geft I., Shah P. K., Lew A. S., Rodriguez L., Weiss T., Maddahi J., Berman D. S., Charuzi Y., Swan H. J. Intravenous streptokinase in evolving acute myocardial infarction. Am J Cardiol. 1984 May 1;53(9):1209–1216. doi: 10.1016/0002-9149(84)90066-3. [DOI] [PubMed] [Google Scholar]
  4. Garabedian H. D., Gold H. K., Yasuda T., Johns J. A., Finkelstein D. M., Gaivin R. J., Cobbaert C., Leinbach R. C., Collen D. Detection of coronary artery reperfusion with creatine kinase-MB determinations during thrombolytic therapy: correlation with acute angiography. J Am Coll Cardiol. 1988 Apr;11(4):729–734. doi: 10.1016/0735-1097(88)90204-5. [DOI] [PubMed] [Google Scholar]
  5. Gelehrter T. D., Sznycer-Laszuk R. Thrombin induction of plasminogen activator-inhibitor in cultured human endothelial cells. J Clin Invest. 1986 Jan;77(1):165–169. doi: 10.1172/JCI112271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gore J. M., Roberts R., Ball S. P., Montero A., Goldberg R. J., Dalen J. E. Peak creatine kinase as a measure of effectiveness of thrombolytic therapy in acute myocardial infarction. Am J Cardiol. 1987 Jun 1;59(15):1234–1238. doi: 10.1016/0002-9149(87)90896-4. [DOI] [PubMed] [Google Scholar]
  7. Hogg K. J., Hornung R. S., Howie C. A., Hockings N., Dunn F. G., Hillis W. S. Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of the ST segment as a non-invasive marker. Br Heart J. 1988 Oct;60(4):275–280. doi: 10.1136/hrt.60.4.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hogg K. J., Lees K. R., Hornung R. S., Howie C. A., Dunn F. G., Hillis W. S. Electrocardiographic evidence of myocardial salvage after thrombolysis in acute myocardial infarction. Br Heart J. 1989 Jun;61(6):489–495. doi: 10.1136/hrt.61.6.489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kennedy J. W., Martin G. V., Davis K. B., Maynard C., Stadius M., Sheehan F. H., Ritchie J. L. The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Randomized Trial. Circulation. 1988 Feb;77(2):345–352. doi: 10.1161/01.cir.77.2.345. [DOI] [PubMed] [Google Scholar]
  10. Konkle B. A., Ginsburg D. The addition of endothelial cell growth factor and heparin to human umbilical vein endothelial cell cultures decreases plasminogen activator inhibitor-1 expression. J Clin Invest. 1988 Aug;82(2):579–585. doi: 10.1172/JCI113635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krucoff M. W., Green C. E., Satler L. F., Miller F. C., Pallas R. S., Kent K. M., Del Negro A. A., Pearle D. L., Fletcher R. D., Rackley C. E. Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. Am J Cardiol. 1986 Apr 15;57(11):916–922. doi: 10.1016/0002-9149(86)90730-7. [DOI] [PubMed] [Google Scholar]
  12. Magnani B. Plasminogen Activator Italian Multicenter Study (PAIMS): comparison of intravenous recombinant single-chain human tissue-type plasminogen activator (rt-PA) with intravenous streptokinase in acute myocardial infarction. J Am Coll Cardiol. 1989 Jan;13(1):19–26. doi: 10.1016/0735-1097(89)90543-3. [DOI] [PubMed] [Google Scholar]
  13. Melandri G., Tartagni F., Branzi A., Berardi C., Bruscoli F., Monetti N., Magnani B. La stima enzimatica dell'area infartuale nei pazienti sottoposti a terapia trombolitica. Cardiologia. 1988 Jan;33(1):61–67. [PubMed] [Google Scholar]
  14. Nawroth P. P., Stern D. M. Endothelial cell procoagulant properties and the host response. Semin Thromb Hemost. 1987 Oct;13(4):391–397. doi: 10.1055/s-2007-1003516. [DOI] [PubMed] [Google Scholar]
  15. Neri Serneri G. G., Gensini G. F., Abbate R., Mugnaini C., Favilla S., Brunelli C., Chierchia S., Parodi O. Increased fibrinopeptide A formation and thromboxane A2 production in patients with ischemic heart disease: relationships to coronary pathoanatomy, risk factors, and clinical manifestations. Am Heart J. 1981 Feb;101(2):185–194. doi: 10.1016/0002-8703(81)90665-7. [DOI] [PubMed] [Google Scholar]
  16. O'Rourke M., Baron D., Keogh A., Kelly R., Nelson G., Barnes C., Raftos J., Graham K., Hillman K., Newman H. Limitation of myocardial infarction by early infusion of recombinant tissue-type plasminogen activator. Circulation. 1988 Jun;77(6):1311–1315. doi: 10.1161/01.cir.77.6.1311. [DOI] [PubMed] [Google Scholar]
  17. Seitz R., Blanke H., Prätorius G., Strauer B. E., Egbring R. Increased thrombin activity during thrombolysis. Thromb Haemost. 1988 Jun 16;59(3):541–542. [PubMed] [Google Scholar]
  18. Small M., Lowe G. D., Douglas J. T., Hutton I., Lorimer A. R., Forbes C. D. Thrombin and plasmin activity in coronary artery disease. Br Heart J. 1988 Sep;60(3):201–203. doi: 10.1136/hrt.60.3.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Sobel B. E., Roberts R., Larson K. B. Estimation of infarct size from serum MB creatine phosphokinase activity: Applications and limitations. Am J Cardiol. 1976 Mar 31;37(4):474–485. doi: 10.1016/0002-9149(76)90385-4. [DOI] [PubMed] [Google Scholar]
  20. Whatley R. E., Zimmerman G. A., McIntyre T. M., Taylor R., Prescott S. M. Production of platelet-activating factor by endothelial cells. Semin Thromb Hemost. 1987 Oct;13(4):445–453. doi: 10.1055/s-2007-1003521. [DOI] [PubMed] [Google Scholar]
  21. White H. D., Norris R. M., Brown M. A., Takayama M., Maslowski A., Bass N. M., Ormiston J. A., Whitlock T. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med. 1987 Oct 1;317(14):850–855. doi: 10.1056/NEJM198710013171402. [DOI] [PubMed] [Google Scholar]
  22. de Zwaan C., Willems G. M., Vermeer F., Res J., Verheugt F. W., van der Laarse A., Simoons M. L., Lubsen J., Hermens W. T. Enzyme tests in the evaluation of thrombolysis in acute myocardial infarction. Br Heart J. 1988 Feb;59(2):175–183. doi: 10.1136/hrt.59.2.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. van der Laarse A., Vermeer F., Hermens W. T., Willems G. M., de Neef K., Simoons M. L., Serruys P. W., Res J., Verheugt F. W., Krauss X. H. Effects of early intracoronary streptokinase on infarct size estimated from cumulative enzyme release and on enzyme release rate: a randomized trial of 533 patients with acute myocardial infarction. Am Heart J. 1986 Oct;112(4):672–681. doi: 10.1016/0002-8703(86)90460-6. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES