METAANALYSIS OF ALL AVAILABLE PUBLISHED CLINICAL-TRIALS (1958-1990) ON THROMBOLYTIC THERAPY FOR AMI - RELATIVE EFFICACY OF DIFFERENT THERAPEUTIC STRATEGIES

Data of approximately 100000 acute myocardial infarction (AMI) patient s, having been treated in 300 clinical trials on thrombolysis for AMI, were included in a meta-analysis comparing the relative efficacy of c urrently employed plasminogen activators and investigating the influen ce of early versus late initiation of conjunctive heparin therapy. Ear ly patency after thrombolysis with novel plasminogen activators or int racoronary lysis was significantly higher in comparison with standard streptokinase; this superiority however, did translate into significan tly lower mortality rates only for rt-PA. Early initiation of heparin anticoagulation exerted only little influence on early patency, which appears to be determined by the thrombolytic strategy. Reocclusion rat es showed a weak correlation with patency; a clear reduction of reoccl usion rates was seen when heparin was initiated early. Cumulative in-h ospital mortality rates ranged from 4% to 9%. The effects of heparin o n mortality were variable; a statistically significant reduction of mo rtality was noted after rt-PA but not after streptokinase and APSAC, w hen early versus late conjunctive heparin was compared. Early initiati on of anticoagulant therapy is mandatory after thrombolysis with rt-PA ; the time of initiation of prophylactic anticoagulation after strepto kinase or APSAC did not influence the outcome significantly. Thromboly tic therapy with i.v. rt-PA proved to be superior to all other thrombo lytic strategies currently employed, provided, an effective antithromb otic treatment is coadministered.