Fibrinogen concentration and coronary artery reperfusion after intravenous anisoylated plasminogen streptokinase activator complex or intracoronary streptokinase therapy.

In a US study, anisoylated plasminogen streptokinase activator complex (APSAC), 30U intravenously over 2 minutes, was compared with streptokinase, about 150,000U by intracoronary infusion over 60 minutes. Included in the study were 106 patients with acute myocardial infarction for whom both angiographic data and coagulation study results were available. 58 of these patients received APSAC and 48 streptokinase. The degree of hypofibrinogenaemia and the percentage of patients who had a drop of greater than 10% in plasma fibrinogen was more evident with high dose intravenous APSAC treatment than with lower dosages of intracoronary streptokinase. This laboratory abnormality was not predictive of successful reperfusion in APSAC-treated patients. The dose of streptokinase administered was not correlated with the presence or absence of the lytic state or with reperfusion. However, 10 patients treated with streptokinase showed reperfusion without an apparent effect on the fibrinogen concentration and further studies are needed to determine whether treatment effects were limited to the coronary artery by regional infusion. Similarly, 2 APSAC-treated patients had groin bleeding without a decrease in plasma fibrinogen. Therefore, a final conclusion regarding the contribution of a lytic state to bleeding must await further analysis.