Chua Kin Wei, Muthuvadivelu Sreevali, Abdul Rani Rosilawati, Ong Siew Chin, Hussin Narwani, Cheah Wee Kooi
Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Perak, Malaysia.
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
Curr Ther Res Clin Exp. 2021 Aug 21;95:100641. doi: 10.1016/j.curtheres.2021.100641. eCollection 2021.
In Malaysia, knowledge regarding the clinical efficacy of tenecteplase (TNK), a fibrin-specific tissue-plasminogen activator, is limited.
To evaluate the effectiveness and tolerability of TNK in patients with ST-segment-elevation myocardial infarction in a secondary referral Malaysian hospital.
This was a single-center retrospective case series based on the medical records of patients with ST-segment-elevation myocardial infarction admitted to the cardiac care unit between January 2016 and May 2019. Data regarding the mortality status and date of death were collected from the database of the National Registration Department of Malaysia.
Data for 30 patients with ST-segment-elevation myocardial infarction, who received weight-adjusted doses of TNK, were analyzed. The patients' mean (SD) age was 62 (14) years, and 77% were men. The median time to treatment was 265 minutes (interquartile range = 228-660 minutes), and the clinical success rate of thrombolysis was 79%. The overall all-cause in-hospital mortality rate was 33%. The 1-year survival rates were higher in patients achieving a time to treatment ≤360 minutes ( = 0.03), with a trend toward greater survival in this group at 30 days. Similarly, a trend toward lower in-hospital all-cause mortality was observed in this group (21% vs 50%; = 0.12). Only 1 patient (3%), who had a HAS-BLED score based on hypertension, abnormal liver/renal function, stroke history, bleeding history or predisposition, labile international normalized ratio, old age, drug/alcohol use of 5, developed major bleeding that required blood transfusion. No cases of ischemic stroke, nonmajor bleeding, in-hospital reinfarction, or TNK-induced allergic reaction were identified.
We hypothesized that the mortality-related outcomes of TNK in patients with ST-segment-elevation myocardial infarction were influenced by TTT, with TTT ≤360 minutes indicating a better prognosis than TTT >360 minutes. TNK-induced bleeding-related complications were minimal in low-risk patients. Further local studies are needed to compare TNK's profile with that of streptokinase, which is a common agent currently used in clinical practice in Malaysian public hospitals. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
在马来西亚，关于纤维蛋白特异性组织纤溶酶原激活剂替奈普酶（TNK）临床疗效的知识有限。
评估TNK在马来西亚一家二级转诊医院的ST段抬高型心肌梗死患者中的有效性和耐受性。
这是一项单中心回顾性病例系列研究，基于2016年1月至2019年5月入住心脏监护病房的ST段抬高型心肌梗死患者的病历。从马来西亚国家登记部门的数据库收集有关死亡状态和死亡日期的数据。
分析了30例接受体重调整剂量TNK的ST段抬高型心肌梗死患者的数据。患者的平均（标准差）年龄为62（14）岁，77%为男性。治疗的中位时间为265分钟（四分位间距=228 - 660分钟），溶栓的临床成功率为79%。总体全因住院死亡率为33%。治疗时间≤360分钟的患者1年生存率更高（=0.03），该组在30天时生存趋势更明显。同样，该组住院全因死亡率有降低趋势（21%对50%；=0.12）。只有1例患者（3%），其基于高血压、肝/肾功能异常、中风病史、出血病史或易感性、国际标准化比值不稳定、老年、药物/酒精使用情况的HAS - BLED评分为5，发生了需要输血的大出血。未发现缺血性中风、非大出血、院内再梗死或TNK诱导的过敏反应病例。
我们假设TNK在ST段抬高型心肌梗死患者中与死亡率相关的结局受治疗时间（TTT）影响，TTT≤360分钟表明预后优于TTT>360分钟。在低风险患者中，TNK诱导的出血相关并发症极少。需要进一步的本地研究来比较TNK与链激酶的情况，链激酶是马来西亚公立医院目前临床实践中常用的药物。（《当前治疗研究与临床实验》。2021年；82:XXX - XXX）
