Vincze Z, Brugos B
3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
Pharmazie. 2008 Mar;63(3):245-6.
Thrombolytic agents activate plasminogen and induce a systemic fibrinolytic and anticoagulant state. Two thrombolytic drugs are used frequently in practice: streptokinase (SK) and alteplase (t-PA). Streptokinase mainly undergoes renal elimination with a half-life of 11-17 min, while alteplase is eliminating by the liver with a half-life of 4-6 min. Our goal was to examine whether renal and hepatic function influence the elimination and metabolism of thrombolytics and the efficacy of percutaneous coronary intervention (PCI) after using alteplase or streptokinase. 416 patients with myocardial infarction (MI) were treated from January 2001 to December 2003 (228 male and 189 female). Alteplase was used in 9 men and 6 women (mean age: 53.88 +/- 9.61 vs. 65.33 +/- 9.87 years, p = 0.07). Patients who underwent rescue PCI after administration of alteplase had slightly higher hepatic enzyme levels/alanine transaminase (ALT): 47.85 vs. 41.4 U/l; gamma-glutamyl transpeptidase (GGT): 69.5 vs. 44.8 U/l/. All patients treated with alteplase survived, rescue PCI was done in 8 cases. Streptokinase was used in 36 men and 28 women (mean age: 63.33 +/- 10.51 vs. 63 +/- 12.03 years, p = 0.9). We did not find a difference between serum creatinine levels of patients who received streptokinase and underwent PCI as compared to those who had not. Rescue PCI was done in 16 cases. 12 patients died in this group. In conclusion we have not found a significant correlation between the use of the thrombolytics and hepatic or renal function; this could indicate that such a slight impairment of liver and renal function does not influence pharmacokinetic properties of thrombolytics.
溶栓剂可激活纤溶酶原并诱导全身纤溶和抗凝状态。在实际应用中常用两种溶栓药物：链激酶（SK）和阿替普酶（t-PA）。链激酶主要经肾脏清除，半衰期为11 - 17分钟，而阿替普酶经肝脏清除，半衰期为4 - 6分钟。我们的目标是研究肾功能和肝功能是否会影响溶栓剂的清除与代谢以及使用阿替普酶或链激酶后经皮冠状动脉介入治疗（PCI）的疗效。2001年1月至2003年12月期间对416例心肌梗死（MI）患者进行了治疗（男性228例，女性189例）。9例男性和6例女性使用了阿替普酶（平均年龄：53.88±9.61岁 vs. 65.33±9.87岁，p = 0.07）。使用阿替普酶后接受补救性PCI的患者肝酶水平/丙氨酸转氨酶（ALT）略高：47.85 vs. 41.4 U/L；γ-谷氨酰转肽酶（GGT）：69.5 vs. 44.8 U/L。所有使用阿替普酶治疗的患者均存活，8例进行了补救性PCI。36例男性和28例女性使用了链激酶（平均年龄：63.33±10.51岁 vs. 63±12.03岁，p = 0.9）。我们发现接受链激酶治疗并进行PCI的患者与未进行PCI的患者血清肌酐水平无差异。16例进行了补救性PCI。该组有12例患者死亡。总之，我们未发现溶栓剂的使用与肝功能或肾功能之间存在显著相关性；这可能表明肝肾功能的这种轻微损害不会影响溶栓剂的药代动力学特性。
