Bolus fibrinolytics tenecteplase and reteplase showed comparable efficacy and safety to accelerated infusion tPA, while lanoteplase had a significantly higher rate of intracranial hemorrhage.
Systematic Review
Are bolus fibrinolytics (reteplase, lanoteplase, tenecteplase) as effective and safe as accelerated infusion tPA in patients with acute myocardial infarction?
Bolus fibrinolytics like tenecteplase and reteplase offer a more convenient administration route with comparable efficacy and safety to accelerated infusion tPA for acute myocardial infarction.
CONTEXT: New bolus fibrinolytics derived from the human tissue-type plasminogen activator (tPA) have emerged as a means of dissolution of occlusive thrombosis associated with acute myocardial infarction. OBJECTIVE: To review the new bolus fibrinolytic drugs derived from tPA: reteplase, lanoteplase, and tenecteplase. DATA SOURCES: The MEDLINE, EMBASE, and Current Contents databases were searched for articles from 1983 to 2001, using the index terms pharmacokinetics, pharmacodynamics, plasminogen activator, reteplase, lanoteplase, and tenecteplase. Additional data sources included bibliographies of articles identified on MEDLINE, EMBASE, and Current Content, inquiry of experts and pharmaceutical companies, and preliminary data presented at recent national and international cardiology conferences. STUDY SELECTION: We selected for review studies that evaluated the pharmacokinetics and pharmacodynamics of reteplase, lanoteplase, and tenecteplase, and assessed the effects of these bolus fibrinolytic drugs on the angiographic and immediate and long-term outcomes of patients. Of 138 articles identified, 38 were analyzed. DATA EXTRACTION: Data quality was determined by publication in the peer-reviewed literature or presentation at an official cardiology society-sponsored meeting. DATA SYNTHESIS: Tenecteplase and reteplase are comparable with accelerated infusion recombinant tPA in terms of efficacy and safety but more convenient because they are administered by bolus injection. Lanoteplase and heparin bolus plus infusion is as effective as tPA with regard to mortality, but the rate of intracranial hemorrhage is significantly higher. CONCLUSION: Given the ease of administration and the similar outcomes compared with accelerated infusion recombinant tPA, it is likely that a key component of contemporary reperfusion will include a bolus fibrinolytic.
Joan Llevadot (Wed,) conducted a systematic review in Acute myocardial infarction. Bolus fibrinolytic drugs (reteplase, lanoteplase, tenecteplase) vs. Accelerated infusion recombinant tPA was evaluated on Angiographic and immediate and long-term outcomes (efficacy and safety). Bolus fibrinolytics tenecteplase and reteplase showed comparable efficacy and safety to accelerated infusion tPA, while lanoteplase had a significantly higher rate of intracranial hemorrhage.
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