Intravenous bolus administration of recombinant tissue plasminogen activator to patients with acute myocardial infarction

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Abstract
This open-label pilot study was designed to investigate the efficacy, in terms of coronary recanalization, and safety of three doses of single-chain recombinant tissue-type plasminogen activator (alteplase) given by bolus injection to patients with acute myocardial infarction. Sixty minutes after bolus injection of 70 mg (study group A, 25 patients), 50 mg (study group B, 29 patients), or 60 mg (study group C, 28 patients) of alteplase, coronary recanalization was apparent in 72% (95% Cl, 54% to 89%), 45% (95% Cl, 27% to 63%), and 32% (95% Cl, 15% to 49%) of patients, respectively. An additional bolus of 20 mg of alteplase was administered immediately to all patients in group C and to the patients in groups A and B in whom recanalization was incomplete. Coronary recanalization at 90 minutes after the start of thrombolytic treatment averaged 72% (range, 54% to 90%), 61% (range, 43% to 70%), and 43% (range, 24% to 61%) in study groups A, B, and C, respectively. Only minor bleeding complications were observed. These preliminary findings suggest that a 70-mg bolus injection of alteplase is an effective dose for the treatment of acute myocardial infarction. A large clinical trial is warranted to confirm our results and to established the safety of this regimen.