[Rescue thrombolysis with repeated doses of streptokinase in acute myocardial infarct. A preliminary report].

In patients with persistent acute ischemia and early reocclusion after thrombolytic therapy, the available therapeutic options are optimum drug pharmacologic treatment or a mechanical revascularization. Recently, repeated doses of the same thrombolytic agent used (rescue thrombolysis) have been considered. We report our experience in seven patients with acute myocardial infarction treated with conventional streptokinase dose, within the first 6 hs after onset of the symptoms, and whom due to persistent myocardial ischemia or early reocclusion, hemodynamic instability, significative area of myocardium at risk, failure of maximal doses of conventional therapeutic and inaccessibility for performed mechanical revascularization, a second dose of streptokinase was successfully employed in the early (1:45 to 2:30 hs) and late (48 to 50:00 hs) phase, without hemorrhagic complications and without hypersensitivity effects. In every case rescue thrombolysis allowed to limit the time of ischemia and the extension of the myocardial infarction, demonstrated by indirect clinical criteria, improvement in hemodynamic instability and in the ventricular ejection fraction, that can be considered as a postinfarction myocardial function index, as well as by the reduced in-hospital mortality. These findings suggest that in patients with acute myocardial infarction treated with thrombolytic therapy, and persistent acute ischemia or early reocclusion, a second dose of streptokinase could be a safe and effective therapeutic option. Our successful results will lead to a prospective trial.