Research Article
Volume 5 Issue 1 - 2021
Can the Adjunctive Therapy Increase the Efficacy of Streptokinase in ST Elevation Myocardial Infarction?
Souissi Sami*, Ben Turkia Hela, Ghazali Hanene, Chermiti Ines, Zaouche Khadija and Keskes Syrine
Emergency Department, Regional Hospital of Ben Arous, Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
*Corresponding Author: Souissi Sami, Emergency Department, Regional Hospital of Ben Arous, Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia.
Received: November 18, 2020; Published: December 10, 2020




Abstract

Introduction: In ST segment elevation acute myocardial infarction (STEMI), pharmaco-invasive therapy with thrombolytic regimens is the cornerstone of achieving reperfusion, when primary PCI can’t be performed timely.

The combination of thrombolysis with modern adjunctive antithrombotic therapy (dual antiplatelets therapy and low molecular weight heparin) has been widely examined in large clinical studies with fibrin specific fibrinolytics. But its effects when streptokinase is used are not sufficiently known.

Can the modern antithrombotic adjunctive therapy increase the efficacy of streptokinase?

Aim of the Study: The aim of this study was to evaluate the efficiency and the safety of the use of the modern adjunctive therapy in patients treated with Streptokinase for STEMI.

Methods: A retroprospective analysis of prospective registry included patients with ST segment elevation acute myocardial infarction who were treated with Streptokinase. Two groups were distinguished: The examined group (EG) included patients treated with modern adjunctive antithrombotic therapy enrolled from January 2009 to March 2012 and the control group (CG) included patients treated with conventional adjunctive (aspirin and unfractionated heparin) therapy enrolled from February to December 2008. Comparative study between the two groups according to the coronary reperfusion defined by clinical criteria’s and bleeding risk.

Results: Inclusion of 271 patients. Mean age = 58 ± 11 years old, 85% were male. Forty-six patients were included in the control group, 225 patients in the examined group. Mean age and sex-Ratio were comparable in the two groups with respectively 57 ± 11 versus (vs) 58 ± 12 years (p = 0.36) and 4.1 versus 6.1(p = 0.45). The comparative study of cardiovascular risk factors between the first versus the second group (%): Current smoking (72) vs (77) (p = 0.45); Diabetes (39) vs (26) (p = 0.07); Hypertension (35) vs (28) (p = 0.36); dyslipidemia (17) vs (11) (p = 0.21). The mean delay onset of chest pain- first medical contact was about 3 hours in the two groups. There is no significative difference between the two groups according the early complications (N): Cardiogenic shock (1) in the first group vs (14) (p = 0.14); acute heart failure (9) vs (22) (p = 0.15); hematemesis (1) vs (6) (p = 0.8); intracranial bleeding (0) vs (2) (p = 0.75).

Thrombolysis success was higher in the examined group 63.3% versus 41.3% in the control group (p = 0.001).

Conclusion: In the STEMI patients; the modern adjunctive antithrombotic therapy can improve the efficacy of pharmacological reperfusion with streptokinase without enhancing bleeding risk.

Keywords: Myocardial Infarction; Streptokinase; Fibrinolysis Failure; Bleeding; Adjunctive Therapy

References

  1. TIMI Study Group. “The Thrombolysis in Myocardial Infarction (TIMI) Trial. Phase I Findings”. The New England Journal of Medicine14 (1985): 932-936.
  2. Dalen JE., et al. “Six- and twelve-month follow-up of the phase I Thrombolysis in Myocardial Infarction (TIMI) trial”. The American Journal of Cardiology 4 (1988): 179-185.
  3. Capodanno D., et al. “Management of adjunctive antithrombotic therapy in STEMI patients treated with fibrinolysis undergoing rescue or delayed PCI”. Thrombosis and Haemostasis 5 (2015): 945-957.
  4. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group”. Lancet London England 8607 (1988): 349-360.
  5. CAPRIE Steering Committee. “A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)”. Lancet 348 (1996): 1329-1339.
  6. Steg PG., et al. “ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation”. European Heart Journal 33 (2012): 2569-2619.
  7. Topol EJ. “Acute myocardial infarction: thrombolysis”. Heart 83 (2000): 122.
  8. Fitzgerald DJ., et al. “Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction”. Circulation 77 (1988): 142-150.
  9. Meijer A., et al. “Aspirin versus coumadin in the prevention of reocclusion and recurrent ischemia after successful thrombolysis: a prospective placebo controlled angiographic study: results of the APRICOT Study”. Circulation 87 (1993): 152430.
  10. Borja I., et al. “017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
  11. Quinn MJ., et al. “Ticlopidine and clopidogrel”. Circulation 100 (1999): 166772.
  12. Patrono C., et al. “Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy”. Chest 126 (2004): 234S-264S.
  13. Herbert JM., et al. “The antiaggregating and antithrombotic activity of clopidogrel is potentiated by aspirin in several experimental models in the rabbit”. Thrombosis and Haemostasis 80 (1998): 512-518.
  14. Sabatine MS., et al. “Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation”. The New England Journal of Medicine 352 (2005): 1179-1189.
  15. Ferreiro JL., et al. “Clopidogrel response variability: current status and future directions”. Thrombosis and Haemostasis 102 (2009): 7-14.
  16. Bonello L., et al. “Consensus and future directions on the definition of high ontreatment platelet reactivity to adenosine diphosphate”. Journal of the American College of Cardiology 56 (2010): 919-933.
  17. Antman EM., et al. “Enoxaparin versus unfractionated heparin as antithrombin therapy in patients receiving fibrinolysis for ST elevation MI: design and rationale for the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment Thrombolysis in Myocardial Infarction–Study 25 (ExTRACT– TIMI 25)”. American Heart Journal 149 (2005): 217-226.
  18. Lavi S., et al. “Efficacy and safety of enoxaparin compared with unfractionated heparin in the pharmacoinvasive management of acute ST-segment elevation myocardial infarction: Insights from the TRANSFER-AMI trial”. American Heart Journal 163 (2012): 176-181.
Citation: Souissi Sami., et al. “Can the Adjunctive Therapy Increase the Efficacy of Streptokinase in ST Elevation Myocardial Infarction?”. EC Emergency Medicine and Critical Care 5.1 (2021): 14-19.

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