A PILOT-STUDY ON BOLUS ADMINISTRATION OF RECOMBINANT STAPHYLOKINASE FOR CORONARY-ARTERY THROMBOLYSIS

Recombinant staphylokinase (Sak) is a highly fibrin-specific thromboly tic agent but the optimal dose and mode of administration remain to be defined. Intravenous (i.v.) infusion over 5 min of 20 mg Sak in 12 pa tients with acute myocardial infarction induced complete coronary pate ncy (TIMI perfusion grade 3) in 7 patients (58%) within 60 min. In 3 o f the 5 patients with no or suboptimal flow (TIMI grade 0, 1 or 2) at 60 min, an additional 10 mg i.v. bolus of Sak resulted in TIMI grade 3 flow at 90 min. No major treatment-related complication occurred. Res idual fibrinogen and alpha(2)-antiplasmin levels at 90 min were 110 +/ - 6.0% and 98 +/- 4.1% (mean +/- SEM) of baseline, respectively. Media n antibody-related Sak-neutralizing activity was low at baseline (0.0 mu g/ml) and after 1 week (0.5 mu g/ml) but increased from day 10 on ( to 4.0 mu g/ml). Thus, bolus thrombolysis with Sak may induce efficien t coronary artery recanalization while preserving circulating fibrinog en and alpha(2)-antiplasmin, Comparative trials of coronary thrombolys is with double-bolus Sak appear to be warranted.