Retreatment with alteplase for early signs of reocclusion after thrombolysis. The European Cooperative Study Group.

Abstract

Recurrent chest pain with new ST-segment elevation was observed in 26 of 652 patients (4%) with myocardial infarction in a clinical trial of alteplase (recombinant tissue-type plasminogen activator; 100 mg) and aspirin with or without heparin. Clinical and electrocardiographic signs of reocclusion were treated with a second dose of alteplase: 50 mg in 20 patients with signs of reocclusion < or = 24 hours after initial therapy, and 100 mg in 5 patients with signs between 24 and 77 hours, and in 1 patient with early signs of reocclusion. Pain and ST changes disappeared within 100 minutes (median 50). D-dimer determinations in 15 patients were increased, indicating activation of the coagulation system. Signs of reocclusion occurred despite adequate anticoagulation with heparin in 5 of 11 patients in whom coagulation measurements were available. No excess bleeding was observed in patients who received a second dose of alteplase. Retreatment with alteplase is feasible and provides an alternative for angioplasty in patients with clinical and electrocardiographic signs of reocclusion early after thrombolytic therapy.

Cite this paper

@article{Simoons1993RetreatmentWA, title={Retreatment with alteplase for early signs of reocclusion after thrombolysis. The European Cooperative Study Group.}, author={Maarten L. Simoons and J M M C Arnout and Marcel J B M van den Brand and K N{\"{y}ssen and Marc Verstraete}, journal={The American journal of cardiology}, year={1993}, volume={71 7}, pages={524-8} }