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The beneficial effects of intravenous bolus injection of urokinase followed by conventional selective intracoronary thrombolysis Tomoyasu Yahagi 1 , Takao Araki 1 , Tamio Miura 1 , Toshikazu Goto 1 , Hiroaki Saito 1 , Taketsugu Ohyama 1 , Motoyuki Matsui 1 , Masayuki Suzuki 1 , Mikio Saito 1 , Koichi Yokoyama 1 , Sho Otomo 1 1Department of Internal Medicine, Yamagata Prefectural Central Hospital pp.517-523
Published Date 1988/5/15
DOI https://doi.org/10.11477/mf.1404205254
  • Abstract
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In order to recanalize the occluded coronary ar-teries in patients with acute myocardial infarction (AMI) as soon as possible and limit the infarct size. we evaluated the effects of intravenous bolus injec-tion of urokinase (UK) followed by intracoronary thrombolysis (ICT). Eighty-seven patients were divided into two groups ; one group with intravenous injection of UK (the IV group, 34 cases) and another group without (the IC group, 53 cases). They were also subdivided into three groups each ; recanaliza-tion before ICT (group A, 21 vs 20 cases), recanaliza-tion after ICT (group B, 10 vs 27 cases), recanaliza-tion not achieved (group C, 3 vs 6 cases). The amount of UK injected during ICT was not significantly different between N and IC groups (67.8±30.5 vs 68.3±34.0×104 units). Intravenous UK in IV group was 24.9×104 units. Total recanalization rate after ICT was equivalent between the two groups (N : 88.2%, IC: 88.7%), but recanalization rate before ICT was significantly higher in the N group (61. 8 vs 37.7%, p<0.05). No significant differences were observed in the maximum values of CK-MB and CK, the elapsed time from the onset of AMI to the maximum values of these enzymes, the global left ventricular ejection fraction and the regional wallmotion. Interestingly, cardiac death was most infre-quent in the N-A group, who received the intra-venous UK before ICT and recanalization was achieved before ICT (4.8% at 1 month after the onset, 0% at 1 year, 4.8% in the overall estimation). The serious complications including hematoma of the puncture site was not observed. These favorable effects were attributed to the intravenous admini-stration of 24.9×104 units of UK because the higher recanalization rate before ICT was also observed even modifying the recanalization criteria, the blood coagulation parameters show the marked dominancy of fibrinopeptide Bβ15-42 over fibrinopeptide An in-dicating the exaggerated fibrinolysis, and the two groups (N and IC) were equivalent in terms of characteristics of the cases, the cares given, the elap-sed time from the onset of AMI, to ICT etc. Thus relatively small amount of UK injected intravenously early in AMI led to the higher recanalization rate before ICT and this was associated with the better prognosis.


Copyright © 1988, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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