Rentrop reported successful recanalization of coronary thrombotic occlusion with intracoronary infusion of strep-tokinase in patients. Streptokinase was the first throm-bolytic agent employed, and its usefulness was first documented in the Italian trial of intravenous streptoki-nase (GISSI). This drug remains in use today because it is the least expensive of the available thrombolytic agents and has a low risk for intracranial hemorrhage compared with other agents that are modestly better in dissolving clots. The internationally run British trial, the International Study of Infarct Survival (ISIS–2), showed that an intravenous infusion of 1.5 million units of streptokinase administered over 1 h is not particularly expensive or troublesome to give routinely, and it provides significant reduction in mortality and morbidity in patients seen within 3 hof onset of chest pain. Most important, intra¬venous or subcutaneous heparin is not necessary when streptokinase is used; this reduces the risk for intracranial hemorrhage.
The American run international trial, Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO), demonstrated a modest 14% mortality reduc¬tion over streptokinase. Despite an increased risk of intracranial hemorrhage and the cumbersome use of intravenous heparin for several days, t-PA was established as the thrombolytic drug of choice for the management of acute MI and gained widespread acceptance in the United States. Steptokinase continued to be the main agent used in the UK, Europe, and developing countries with t-PA used for selected cases and for patients allergic to streptokinase.

Страницы: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12