Streptokinase demonstrated a more marked procoagulant action compared with front-loaded alteplase, with greater reductions in fibrinogen and increases in D-dimers and plasmin-antiplasmin complexes (P<0.05).
Observational (n=115)
Does thrombolytic therapy with streptokinase or alteplase increase procoagulant activity in patients with acute myocardial infarction?
Thrombolytic therapy with streptokinase induces a more marked procoagulant action compared to front-loaded alteplase in patients with acute myocardial infarction.
p-value: p=<0.05
BACKGROUND: Thrombolytic therapy in patients with acute myocardial infarction (AMI) is hampered by procoagulant effects. In vitro studies have indicated that plasmin stimulation activates the kallikrein-contact-phase system, resulting in thrombin activation. This prospective comparative study was designed to examine the procoagulant effects of streptokinase or alteplase in AMI. METHODS AND RESULTS: Sixty-one patients with AMI received 1.5 million U of streptokinase or front-loaded alteplase (up to 100 mg) and systemic heparin. Twenty-four patients with AMI and no thrombolytic therapy and 30 control subjects were examined for comparison. Molecular markers of thrombin, plasmin activation, and coagulation activities were determined before therapy and serially for up to 10 days. Moderate thrombin (initial thrombin-antithrombin TAT complex 18+/-5 versus 4+/-0.3 microg/L, P<0.05) and kallikrein (up to 45+/-4 versus 30+/-1 U/L at 3 hours, P<0.01) activation occurs in patients with AMI. D-Dimers are increased (P<0.01), and plasmin is stimulated (P<0.01). Streptokinase and alteplase increase TAT to 50+/-17 and 51+/-18 microg/L at 3 hours and to 50+/-17 and 33+/-14 microg/L at 6 hours, respectively (P<0.01). Kallikrein activity is elevated (P<0. 01) to 76+/-5 and 71+/-7 U/L at 3 hours and 64+/-6 and 47+/-5 U/L by streptokinase and alteplase, respectively, at 6 hours. Reductions in fibrinogen and increases in D-dimers and plasmin-antiplasmin complexes are more marked (P<0.05 and 0.01) after streptokinase versus alteplase. Correlations were found among TAT, kallikrein activity, and plasmin activation (P<0.01). CONCLUSIONS: The data indicate a more marked procoagulant action of the streptokinase regimen compared with front-loaded alteplase, thus supporting the hypothesis of a plasmin-mediated kallikrein activation with consecutive procoagulant action in vivo.
Hoffmeister et al. (Tue,) conducted a observational in Acute Myocardial Infarction (n=115). Streptokinase vs. Front-loaded alteplase (up to 100 mg) was evaluated on Molecular markers of thrombin, plasmin activation, and coagulation activities (p=<0.05). Streptokinase demonstrated a more marked procoagulant action compared with front-loaded alteplase, with greater reductions in fibrinogen and increases in D-dimers and plasmin-antiplasmin complexes (P<0.05).