当前位置： SCI文献检索 > AMERICAN HEART JOURNAL期刊下所有文献 > An angiographic assessment of alteplase: double-bolus and front-loaded infusion regimens in myocardial infarction. DouBLE Study Investigators. Double Bolus Lysis Efficacy.

An angiographic assessment of alteplase: double-bolus and front-loaded infusion regimens in myocardial infarction. DouBLE Study Investigators. Double Bolus Lysis Efficacy.

Abstract：

BACKGROUND:This study was designed to investigate the efficacy of alteplase double-bolus dosing compared with the front-loaded 90-minute infusion regimen in patients with acute myocardial infarction. Recent pilot studies have suggested that bolus dosing may provide improved efficacy in establishing early, complete, and sustained patency of the infarct-related artery in the thrombolytic treatment of acute myocardial infarction. METHODS AND RESULTS:In this multicenter, randomized, open-label trial, 461 patients with acute myocardial infarction received 100 mg alteplase as a front-loaded 90-minute infusion (15 mg bolus, then 50 mg over a 30-minute period, then 35 mg over a 60-minute period) or double bolus (two 50 mg bolus injections 30 minutes apart). All patients also received intravenous heparin and oral aspirin during and after alteplase treatment. The 90-minute angiographic patency rates were 74.5% in the double-bolus group and 81.4% in the infusion group (p = 0.08). Patency rates were also comparable for the two groups at 60 minutes (76.8% vs 77.5%) and 24 hours (95.5% vs 93.5%) after initiation of treatment. In-hospital mortality rates were 4.5% in the bolus group and 1.3% in the infusion group (p = 0.04); 30-day mortality rates were 4.5% and 1.7%, respectively (p = NS). The two-groups were comparable in frequency of all other adverse events. CONCLUSIONS:Double-bolus alteplase administration produced reperfusion rates comparable to front-loaded infusion, but in-hospital and 30-day mortality rates were higher in the double-bolus group. These findings are in agreement with those of the COBALT megatrial, which also reported a trend to higher mortality rates with double-bolus dosing.

journal_name

Am Heart J

journal_title

American heart journal

authors

Bleich SD,Adgey AA,McMechan SR,Love TW

doi

10.1016/s0002-8703(98)70024-9

subject

Has Abstract

pub_date

1998-10-01 00:00:00

pages

741-8

issue

4 Pt 1

eissn

0002-8703

issn

1097-6744

pii

S0002870398000829

journal_volume

136

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

在线工具

An angiographic assessment of alteplase: double-bolus and front-loaded infusion regimens in myocardial infarction. DouBLE Study Investigators. Double Bolus Lysis Efficacy.