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New Agents and New Insights for Thrombolytic Therapy in Acute Myocardial Infarction: Focus on Anistreplase, Urokinase, and Prourokinase

  • Jeffrey L. Anderson
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 100)

Abstract

Three new agents are currently undergoing clinical trials: anistreplase, intravenous urokinase, and prourokinase. Anistreplase (APSAC) is a complex of anisoylated lys-plasminogen and streptokinase which is injected in a dose of 30 U over 2–5 min. Reperfusion rates of 60+10% and patency rates of 70–75% have been observed when it is given in <4 h. Mortality was reduced 48% after anistreplase in one study (AIMS). Intravenous urokinase has yielded reperfusion or patency rates of 60–70% in limited trial experience, with equivalent effects of TPA in one trial (GAUS). Current usage includes a loading injection (eg, 1.5 million U) followed by a maintenance infusion (eg, 1.5 million U/60–90 min). Combinations of urokinase and TPA are also undergoing testing. Prourokinase is a fibrin-selective precursor form of urokinase undergoing initial trials both as a single agent and in combinations with urokinase and TPA. These agents expand the spectrum of thrombolytic options and may begin to impact clinical therapy in the near future.

Keywords

Acute Myocardial Infarction Thrombolytic Therapy Patency Rate Myocardial Salvage Anisoylated Plasminogen Streptokinase Activator Complex 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Jeffrey L. Anderson
    • 1
    • 2
  1. 1.University of UtahSalt Lake CityUSA
  2. 2.Division of CardiologyLDS HospitalSalt Lake CityUSA

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