June 1, 1995Circulation
More Rapid, Complete, and Stable Coronary Thrombolysis With Bolus Administration of Reteplase Compared With Alteplase Infusion in Acute Myocardial Infarction
Why the study?
Does bolus administration of reteplase improve infarct-related artery patency at 90 minutes compared to standard-dose alteplase infusion in patients with acute myocardial infarction?
Population
606 patients with acute myocardial infarction
Comparison
Reteplase administered as a 10-MU bolus followed… vs Alteplase (TPA) 100 mg i.v. over 3 hours
Design
RCT, randomized to one of four treatment arms
Follow-up
hospital discharge (5 to 14 days)
Authors
Discussion
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Member takes
Implication
Supports double-bolus reteplase over alteplase for early patency in AMI; extends evidence favoring simplified thrombolytic regimens.
Key Points
- The study aims to compare the efficacy of bolus reteplase versus alteplase infusion for thrombolysis in acute myocardial infarction.
- Randomized trial with 606 patients with acute myocardial infarction
- Four treatment arms including varying dosages of reteplase and alteplase
- Coronary arteriography performed at multiple time points to assess artery patency.
- 10 + 10-MU r-PA group achieved 63% TIMI 3 flow at 90 minutes versus 49% for TPA (P = .019)
- Improved ejection fraction in the 10 + 10-MU r-PA group at discharge (53% vs 49%, P = .034)
- Bleeding complications were similar across treatment groups.
Structured PICO
Does bolus administration of reteplase improve infarct-related artery patency at 90 minutes compared to standard-dose alteplase infusion in patients with acute myocardial infarction?
P
Population
606 patients with acute myocardial infarction
I
Intervention
Reteplase (r-PA) administered as a 10-MU bolus followed by 10 MU 30 minutes later (other arms included 15-MU single bolus and 10-MU + 5-MU bolus)
C
Comparator
Alteplase (TPA) 100 mg i.v. over 3 hours
O
Outcome
Infarct-related artery patency (TIMI 3 flow) 90 minutes after initiation of treatmentsurrogate
A double bolus of 10 + 10 MU reteplase achieves more rapid and complete coronary thrombolysis than standard-dose alteplase in acute myocardial infarction, leading to improved left ventricular function.
Cite This Study
Smalling et al. (1995) studied this question.