A PILOT, EARLY ANGIOGRAPHIC PATENCY STUDY USING A DIRECT THROMBIN INHIBITOR AS ADJUNCTIVE THERAPY TO STREPTOKINASE IN ACUTE MYOCARDIAL-INFARCTION

Background The success of streptokinase in acute myocardial infarction is hampered by the high failure rate to achieve early reperfusion. Th is study evaluates the possible benefit of Hirulog (Biogen, Cambridge, Mass), a direct thrombin inhibitor, as adjunct therapy to streptokina se to enhance early patency and prevent rethrombosis. Heparin has been shown to be of very limited benefits in this setting. Methods and Res ults Forty-five patients were randomized to Hirulog or heparin (2:1 ra tio). Coronary angiography documented a TIMI2 or 3 flow after 90 minut es in 77% of the patients treated with Hirulog and streptokinase and i n 47% of patients treated with heparin and streptokinase (P<.05) and a fter 120 minutes in 87% and 47% of patients, respectively (P<.01). TIM I 3 flow was established in 77% of patients with Hirulog compared with 40% with heparin (P<.02). The clinical outcome and the bleeding rate were also favorable to Hirulog; no reocclusion was observed at late an giography performed 4.7 days later. Conclusions Hirulog in this pilot study significantly improved the early patency rate of the infarct-rel ated artery with a favorable clinical profile. This new direct thrombi n inhibitor exhibits promise as adjunctive therapy to thrombolysis.