Systemic Streptokinase In Acute Myocardial Infarction

Abstract

METHODS: In 1980 and 1981 we performed a standard intravenous thrombolysis with streptokinase initiated with 500,000 U.prime-dose in the first half hour, followed by 2.2 Mill. U streptokinase in 20 hours as sustaing dose. A history of high blood pressure, stroke, chronic liver disease, stomach or duodenal ulcers and coagulation defects excluded from streptokinase application. Among 122 patients DZ were more than 70 years old, 30 of them were treated with streptokinase. All patients were given an initial dose of steroids: Prednisone 250 mg—1,500mg. RESULTS: The side effects of streptokinase in both groups were unimportant. Allergic skin reactions were not seen. In some cases there was a short drop in blood pressure, critical shock reactions were observed only in single cases. Bleeding complains most often oc cured as hem orrh age around the venal punctures spots. Total mortality in the 82/83 group was 20% (0 age 75,5 in the subgroup over 70). It is reduced to 11% in the subgroup under 70 years. (Table 1-3, figure l-3). DISCUSSION: In the 1980/81 group treated with the standard inravenous streptokinase there were more patients with acute and prolonged cardiogenic shock whose infarct had started more than 6 hours ago. Here thrombolysis could not lower the mortality. Expected positive effects by improving the flow qualities of the blood and by reopening of closed coronary vessels were not achieved, most probably because the streptokina se application was given to late (table 1, figure 1). In 1984 most of our streptokinase patients underwent later coronary angiography. It will be of interest to control the morphological results of what we think was clinical successful thrombolytic. These data are being reviewed at present and not yet available.