Systemic effects of thrombolytic drugs in acute myocardial infarction: Comparison of intravenous APSAC (BRL 26921) and intracoronary streptokinase

Abstract

The systemic effects of intravenous anisoylated plasminogen-streptokinase activator complex (APSAC; BRL 26921; 30 U) and Intracoronary streptokinase (250 000 U) were compared in 70 patients with acute myocardial infarction. In 5 patients no signs of a systemic lytic state were observed. In all other patients, significant consumption of coagulation and fibrinolytic factors occurred: fibrinogen levels decreased by 85% in the APSAC group and 78% in the streptokinase-treated patients. For plasminogen the decreases were 68% and 64% and for α 2-antiplasmin activity > 95% and 87% (APSAC and streptokinase, respectively). Fibrin(ogen) degradation products were generated to mean levels of 739 mg/L and 355 mg/L, respectively. Although there was a trend for the lytic state to be more profound in the APSAC-treated patients, no difference with the streptokinase group was observed with regard to bleeding complications or therapeutic efficacy, which was 64% and 68% respectively for APSAC and streptokinase. The total fibrinolytic activity, measured as euglobulin clot lysis time, sustained longer in the APSAC group, which might be the reason for the low reocclusion rate (4.5%)) in comparison with the SK group (13%).