THE IMPORTANCE OF SARUPLASE IN THE CONTEXT OF OTHER THROMBOLYTIC MEDICATIONS

The ideal thrombolytic therapy for acute myocardial infarction should produce rapid, maximal and sustained coronary artery reperfusion, avoi d reocclusion, bleeding complications and allergic reactions, be easy to prepare and administer, and be cost-effective. Saruplase is examine d in the light of these criteria. Patency data from trials comparing s aruplase with streptokinase or recombinant tissue-type plasminogen act ivator (rt-PA) show saruplase to be very fast-acting, and data on mort ality indicate an earlier onset of action of saruplase than achieved w ith urokinase. The 30-day mortality rate with saruplase is at least eq uivalent to that of streptokinase, but saruplase has the advantage of being a physiological fibrinolytic agent and, to date, no anti-sarupla se antibodies have been detected, whereas an immunological reaction to streptokinase is well established. The stroke rate associated with sa ruplase treatment is not significantly greater than that seen with str eptokinase or with rt-PA; rates of bleeding complications for saruplas e and streptokinase are virtually identical. Saruplase has qualities s imilar to those of urokinase, which has produced good results in acute myocardial infarction, occluded venous grafts, pulmonary embolism and lower extremity ischaemia, though saruplase is faster-acting. From a pharmacoeconomic standpoint, the use of rt-PA has been restricted in c ountries where high acquisition costs are an important factor; sarupla se, if less expensive than urokinase, will provide a reasonable altern ative to the latter. It is concluded that saruplase is safe, effective , easy to use, does not provoke an allergic response, and compares fav ourably with streptokinase, urokinase and rt-PA; it represents an impo rtant addition to available thrombolytic medications.