الفهرس 
THROMBOLYTIC THERAPYOnly 14 pages are availabe for public view
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Abstract
Plaque rupture, platelet activation and coronary artery thrombus
formation play important role in the pathogenesis of acute myocardial
infarction.
Antithrombotic and antiplatelets are necessary to establish and
maintain complete reperfusion after fibrinolytic therapy.
Fourty patients with acute myocardial infarction underwent a single
blind randomization study. 20 patients received post thrombolytic therapy
UFH as 5000U intravenous bolus, then 30000U/24hrs adjusted to an
activated partial thromboplastin time 2-2.5 X normal [GroupI], and the
other 20 patients received post thrombolytic therapy LMWH (enoxaparin)
as intravenous bolus 30mg, then subcutaneous injections 1mg/kg/12hrs
[Group II], for 3-8 days. The median duration of treatment in both groups
was 5 days.
All patients were subjected to carefull history analysis, complete
general and cardiac examination, serial resting ECGs, assessment of
cardiac enzymes, echocardiography and coronary angiography.
ST-segment resolution at 90 minutes and 180 minutes measured by
electrocardiogram was improved in patients receiving enoxaparin.
Complete, partial and no resolution at 180 minutes was observed in 10%,
50%, 40% in group I respectively vs. 35%, 45%, 20% in group II
respectively (table 9 and fig.2).
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Summary
Coronary angiography was performed within 7-10 days of admission.
There was statistically significant difference between the two groups as
regards the rate of stenosis of the infarct related artery in group I
was(93.8%) vs (77.7%) in group II (table 14 and fig. 4) .
TIMI Flow grading was more improved in enoxaparin treated group
than in unfractionated heparin treated group: TIMI 3 flow 50% versus 0%
respectively, TIMI 2 flow 35% versus 5% respectively, TIMI 1 flow
10% versus 55% respectively and TIMI 0 flow was 5% versus 40%
respectively. Moreover there was statistically significant difference
between the two groups regarding the incidence of intracoronary thrombi,
30% in group I versus 0% in group II (table15,16 and fig. 5,6).
The in hospital morbidity namely early post myocardial infarction
angina, extention of infarction and left ventricular failure was
significantly lower in the enoxaparin group as compared to the UFH
group (5% vs. 15% respectively) (table17 and fig. 7).
Echocardiography was performed on admission after fibrinolytic
therapy, the results revealed no statistically significant difference in the
wall motion score, EF% and thrombi between the two studied groups
(table 10, 11 and fig. 3).
No major drug side effects were encountered in any of the two groups
during the hospital stay.
Combination therapy of streptokinase and LMWH proved to be
effective and safe. It proved to increase the patency rate of the infarct
related artery with tendency for reduction of adverse cardiac events.