TOBY L. SIMON, M.D.; JAMES H. WARE, Ph.D.; JAMES M. STENGLE, M.D.
Because thrombolytic agents, such as streptokinase and urokinase, rapidly dissolve arterial thrombi, clinical investigators have hoped that these agents could reduce mortality from acute myocardial infarction. Ten large multicenter controlled clinical trials have focused on this issue. They are not all comparable because of variations in dosage, duration of infusion, time between onset of symptoms and admission, and methods of randomization; however, composite results from six of these trials, conducted primarily in general hospital wards, suggest that streptokinase reduces mortality. The other four trials, from coronary care units, present conflicting results: two trials showed no effect, and two, still in progress, are showing mortality differences comparable to those in the positive general ward studies; however, the results are not statistically significant. No subgroup that may especially benefit has been identified. The indications for thrombolytic therapy in coronary care units can only be defined by further study.
SIMON TL, WARE JH, STENGLE JM. Clinical Trials of Thrombolytic Agents in Myocardial Infarction. Ann Intern Med. 1973;79:712–719. doi: https://doi.org/10.7326/0003-4819-79-5-712
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Published: Ann Intern Med. 1973;79(5):712-719.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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