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FRONT-LOADED rt-PA MAY REDUCE MORTALITY AFTER MI.

Early studies showed that high doses of recombinant tissue-type plasminogen activator (rt-PA) led to high early reperfusion rates in acute myocardial infarction, but this approach was abandoned because of an unacceptable risk of intracranial hemorrhage. This randomized trial compared a "front-loaded" regimen of rt-PA (a high initial dose followed by a lower-dose infusion) with a standard regimen of anisoylated plasminogen streptokinase activator (APSAC) in 421 patients with acute MI.

The rt-PA was given in an initial bolus of 15 mg, followed by 50 mg over 30 minutes and 35 mg over the next hour. After 90 minutes of treatment, coronary angiography showed that the infarct-related artery was patent in 84 percent of patients receiving rt-PA versus 70 percent of the APSAC group. Early reocclusion rates were higher with rt-PA (10 vs. 2.5 percent), but in-hospital mortality was significantly lower (2.4 vs. 8.1 percent). Patients given rt-PA had fewer overall bleeding complications than those given APSAC (31 vs. 45 percent) and had the same rate of intracranial hemorrhage (1 percent in both groups).

These data suggest that this "front-loaded" regimen of rt-PA may lead to better outcomes. This finding should be verified in other populations using mortality as the main end point.

— THL

Published in Journal Watch General Medicine April 7, 1992

Citation(s):

Neuhaus K L et al. Improved thrombolysis in acute myocardial infarction with front-loaded administration of alteplase: results of the rt-PA-APSAC Patency Study (TAPS). J Am Coll Cardiol 1992 Apr 19 885-891.

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