Pindur G, Sen C, Wenzel E, Jung F, Ozbek C, Schwerdt H, Schieffer H, Bette L, Miyashita C
Abteilung für Klinische Haemostaseologie und Transfusionsmedizin, Universitätskliniken Homburg/Saar, FRG.
Adv Exp Med Biol. 1990;281:389-94. doi: 10.1007/978-1-4615-3806-6_41.
In spite of equivalent clinical efficacy of various thrombolytic agents for the treatment of acute myocardial infarction there is evidence of different drug-depending influences on the haemostatic and fibrinolytic system. In the present study 40 patients with acute myocardial infarction have been investigated. 20 patients received 750,000 and 1.5 mio U streptokinase (SK), respectively, 10 patients 30 mg anisoylated plasminogen streptokinase activator complex (BRL 26921) and 10 patients a combination of 200,000 U urokinase (UK) and 4.5 mio U pro-urokinase (PUK) as a short-term intravenous treatment. Reperfusion of coronary arteries has been achieved in 70 to 100 percent. Major not fatal bleedings occurred in 2 patients. One patient died within 72 hours after beginning of the myocardial infarction. The longest duration of fibrinolytic activity was observed in the BRL 26921 group (half-disappearance time close to 2 h). It was significantly shorter in the SK groups showing a dose-dependency. Plasma concentration of fibrinogen dropped beyond normal levels following SK and BRL 26921, but not under UK/PUK. Plasma viscosity correlated with fibrinogen decrease and displayed a dose-depending relationship with the presence of SK. Haemorheological effects are suggested to be important for the clinical efficacy of thrombolytic therapy in myocardial infarction.
尽管各种溶栓剂治疗急性心肌梗死的临床疗效相当，但有证据表明它们对止血和纤溶系统的影响因药物而异。在本研究中，对40例急性心肌梗死患者进行了调查。20例患者分别接受750,000和150万单位链激酶（SK），10例患者接受30毫克茴香酰化纤溶酶原链激酶激活剂复合物（BRL 26921），10例患者接受200,000单位尿激酶（UK）和450万单位前尿激酶（PUK）的组合进行短期静脉治疗。冠状动脉再灌注率达到70%至100%。2例患者发生了非致命性大出血。1例患者在心肌梗死开始后72小时内死亡。在BRL 26921组中观察到纤溶活性持续时间最长（半衰期接近2小时）。在SK组中明显较短，且呈剂量依赖性。SK和BRL 26921治疗后纤维蛋白原血浆浓度降至正常水平以下，但UK/PUK治疗后未出现这种情况。血浆粘度与纤维蛋白原降低相关，并且与SK的存在呈剂量依赖性关系。血液流变学效应被认为对心肌梗死溶栓治疗的临床疗效很重要。
