medigraphic.com

2003, Número 1

<< Anterior Siguiente >>

Arch Cardiol Mex 2003; 73 (1)


Estrategias para mejorar la reperfusión con terapia fibrinolítica en infarto con elevación del ST-T

Jerjes-Sánchez C, Sosa del Angel E, García SA, Reyes CE, Garza RA

Idioma: Español
Referencias bibliográficas: 80
Paginas: 46-58
Archivo PDF: 126.88 Kb.


RESUMEN

Las estrategias de reperfusión en la fase temprana del infarto con elevación del ST-T tienen como principal objetivo restituir y mantener la perfusión tisular. La terapia fibrinolítica puede considerarse como el tratamiento estándar por su accesibilidad y efectividad para disminuir daño miocárdico y mortalidad. La principal imperfección de esta estrategia de reperfusión radica en el porcentaje no despreciable de fracaso terapéutico y reoclusión por fenómenos de resistencia y retrombosis. La terapia fibrinolítica asociada al ácido acetilsalicílico, puede considerarse como el avance más importante en el tratamiento del infarto con elevación del ST-T. En el sitio del daño vascular, la trombosis inducida por trombina y agregación plaquetaria son los factores más importantes en la fisiopatología de los SCA y el principal mecanismo que puede limitar la efectividad de la terapia fibrinolítica. El conocimiento actual de la fisiopatología subyacente a la trombosis coronaria sugiere que la terapia fibrinolítica puede fracasar para inducir lisis óptima del trombo y refuerza el raciocinio para la combinación de estrategias antitrombóticas y de reperfusión. Podría mejorar su efectividad, un tratamiento adjunto antiplaquetario y antitrombínico intenso y moderno, que a través de diferentes mecanismos modificaría los principales componentes del trombo coronario. El propósito de este artículo es revisar y discutir los mecanismos de resistencia a la terapia fibrinolítica, las estrategias modernas para mejorar la perfusión que incluyen dosis aceleradas de fibrinolíticos, fibrinólisis facilitada, experiencia con heparina de bajo peso molecular y el posible papel de los nuevos antitrombóticos que han demostrado efectividad en el tratamiento de los síndromes coronarios agudos sin elevación del ST-T.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. American Heart Association 2001 Heart and stroke statistical update. Dallas, Texas. American Heart Association, 2000. Available at: http://www.americanheart.org/ statistics/index.htlm. Revisado en febrero 2001.

  2. Atman EM, Braunwald E: Acute myocardial infarction, in Heart Disease, 5th ed, E Braunwald (ed). Philadelphia, Saunders, 1997, pp 1291-140.

  3. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both pr neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 11: 349-360.

  4. Fibrinolytic Therapy Trialists’ (FTT) Collaborative group. Indications for fibrinolytic therapy in suspected acute myocardial infarction. Lancet 1994; 343: 311-322.

  5. The GUSTO angiographic investigators. The Comparative effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function and survival after acute myocardial infarction. N Engl J Med 1993; 329: 1615-1622.

  6. Cannon CP, McCabe CH, Diver DJ, Herson S, Greene RM, Shah PK, et al: Loaded recombinant tissue-type plasminogen activator, anistreplase and combination thrombolytic therapy for acute myocardial infarction (TIMI) 4 trial. J Am Coll Cardiol 1994; 24: 1602-10.

  7. Califf RM, O’Neill W, Stack RS, Aronson L, Dark DB, Mantell S, et al: Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis. Ann Intern Med 1988; 108: 658-62.

  8. Anderson JL, Karagounis LA, Becker LC, Sorensen SG, Menlove RL: TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction. Ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation 1993; 87: 1829-39.

  9. Zhan R, Schiele R, Schneider S, Giit AK, Wiembergen H, Seidil K, et al: Decreasing hospital mortality between 1994 and 1998 in patients with acute myocardial infarction treated with primary angioplasty but not in patients treated with intravenous thrombolysis. J Am Coll Cardiol 2000; 36: 2064-2071.

  10. Jerjes-Sánchez C, Garza-Ruíz A, Gutiérrez-Fajardo P: Trombólisis farmacológica en el infarto agudo del miocardio: lecciones aprendidas después del ISIS-2 y GUSTO I (Parte I). Arch Inst Cardiol Mex 1999; 69: 478-487.

  11. Jerjes-Sánchez C, Garza-Ruíz A, Gutiérrez-Fajardo: Trombólisis farmacológica en el infarto agudo del miocardio: lecciones aprendidas después del ISIS-2 y GUSTO I (Parte II). Arch Inst Cardiol Mex 1999; 69: 570-579.

  12. Jerjes-Sanchez C, Arriaga-Nava R, Martinez-Enriquez A: Accelerated versus standard streptokinase infusion in acute myocardial infarction. Chest 1996; 110: 107S.

  13. Martínez SC, Domínguez JL, Aguirre SJ, Carrillo J, Chuquiure VE, Franco J, et al: Tratamiento del infarto agudo al miocardio con rt-PA en 60 minutos. Estudio Cooperativo. Arch Inst Cardiol Mex 1997; 67: 126-131.

  14. Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators. Single-bolus tecneplase compared with front-loaded alteplasa in acute myocardial infarction: the ASSENT-2 double-blind randomized trial. Lancet 1999; 354: 716-722.

  15. The in Time-II Investigators. Intravenous NPA for the treatment of infarcting myocardium early. Eur Heart J 2000; 21: 2005-2013.

  16. Van Belle E, Lablanche JM, Bauters C, Renaud N, McFadden EP, Bertrand ME: Coronary angioscopic findings in the infarct-related vessel within 1 month of acute myocardial infarction natural history and effect of thrombolysis. Circulation 1998; 97:26-33

  17. Cannon C: Overcoming Thrombolytic resistance. Rationale and initial clinical experience combining thrombolytic therapy and Glycoprotein IIb/IIIa receptor inhibition for acute myocardial infarction. J Am Coll Cardiol 1999; 34: 1395-402.

  18. Rentrop PK: Thrombi in acute coronary syndromes. Circulation 2000; 101: 1619-1637.

  19. Gibson M: A union in reperfusion: the concept of facilitated percutaneous coronary intervention. J Am Coll Cardiol 2000; 36: 1497-1499.

  20. Antman EM, Giugliano OR, Gibson M, Carolyn H. McCabe HC, Coussement P, et al: Abciximab Facilitates the Rate and Extent of thrombolysis. Results of the Thrombolysis in Myocardial Infarction (TIMI) 14 Trial. Circulation 1999; 99: 2720-32.

  21. Coulter SA, Cannon C, Kenneth KA, Antman EM, Van de Werf F, Adgey JJ: High levels of platelet inhibition with abciximab despite heightened platelet activation and aggregation during thrombolysis for acute myocardial infarction. Results from TIMI 14. Circulation 2000; 101: 2690-2695.

  22. Coller BS: GPIIb/IIIa antagonists: Pathophysiologic and therapeutic insights from studies of c7E3 Fab. Thrombo Haemost 1997; 78:730-755.

  23. Ohman EM, Kleiman NS, Gacioch G: Combined accelerated tissue-plasminogen activator and platelet glycoprotein IIb/IIIa integrin receptor blockade with untegrilin in acute myocardial infarction: results of a randomized, placebo-controlled, dose-ranging. Circulation 1997; 32: 381-9.

  24. Ronner E, Van Kesteren H, Zijnen P: Combined therapy with streptokinase and integrelin (abst). J Am Coll 1998; 31suppl A: 191A.

  25. Moliterno DJ, Harrington RA, Krukoff MV: For the investigators more complete and stable reperfusion with platelet IIb/IIIa antagonism plus thrombolysis for AMI: The PARADIGM trial. Circulation 1996; 94 Suppl I: I-553.

  26. Ohman EM, Lincoff AM, Boode C, Candela R, Ellis S, George Bl, et al: Trial of abciximab with and without low-dose reteplase for infarction acute myocardial. Circulation 2000; 101: 2788-2794.

  27. Herrmann HC, Moliterno DJ, Ohman ME, Stebbins AL, Bode C, Betriu A, et al: Facilitation of early percutaneous coronary intervention after reteplase with or without abciximab in acute myocardial infarction (SPEED – GUSTO-4 Pilot Trial). J Am Coll Cardiol 2000; 36: 1489-1496.

  28. Brener SJ, Zeymer U, Adgey JA, Vrobel TR, Ellis SG, Neuhaus KL, et al for the INTRO AMI investigators. Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction (INTRO AMI) Trial. J Am Coll Cardiol 2002; 39: 377.

  29. GUSTO V Investigators. Reperfusión therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibitions: the GUSTO V randomized trial. Lancet 2001; 357: 1905-1914.

  30. Assessment of the safey and efficacy of a new thrombolytic regimen (ASSENT-3) Investigators. Efficacy and safety of tecneplase in combination with enoxaparin, abciximab or unfractionated heparin: the ASSENT-3 randomized trial in acute myocardial infarction. Lancet 2001; 358: 605-613.

  31. Kastrati A, Mehilli J, Dirschinger J, Schricke U, Neverve J, Pache J, et al: Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trial. Lancet 2002; 359: 920-25.

  32. Topol EJ, Moliterno DJ, Herrman HC, Powers ER, Grines CL, Cohen DJ, et al for the TARGET Investigators. Comparison of two platelet glycoprotein IIb/IIIa inhibitors tirofiban and abciximab for the prevention of ischemic events with percutaneous coronary revascularization. N Engl J Med 2001; 344: 1888.1894.

  33. Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, et al for the ADMIRAL Investigators. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001; 344: 1895-1903.

  34. Throckmorton DC: Future trials of antiplatelet agents in cardiac ischemia. N Engl J Med 2001; 1937-1938.

  35. Boden WE, McRay RG: Optimal treatment of acute coronary syndromes. An evolving strategy. N Engl J Med 2001; 1939-1942.

  36. Kong DE, Califf RM, Miller DP: Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation 1998; 28: 29-35.

  37. Quinn MJ, Plow EF, Topol EJ: Platelet glycoprotein IIb/IIIa inhibitors. Recognition of a two-edged sword. Circulation 2002; 106: 379-385.

  38. The GUSTO IV-ACS Investigators. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularization: the GUSTO IV-ACS randomized trial. Lancet 2001; 357: 1915-1924.

  39. Marcus AJ: Aspirin as an antithrombotic medication. N Engl J Med 1983; 309: 1515-1516.

  40. Weksler BB, Tack-Goldman K, Subramanian VA, Gat WA: Cumulative inhibitory effect of low dose aspirin on vascular prostacyclin and platelet thromboxane production in patients with atherosclerosis. Circulation 1985; 71: 332-340.

  41. Roux S, Christeller S, Ludin E: Effects of aspirin on coronary reoclusion and recurrent ischemia after thrombolysis: metaanalysis. J Am Coll Cardiol 1992; 19: 671-675.

  42. Collaborative Group of the Primary Prevention Project (PPP). Low dose aspirin and vitamin E in people at cardiovascular risk: a randomized trial in general practice. Lancet 2001; 387: 89-95.

  43. Bhatt D, Hirsch A, Ringleb PA, Hacke W, Topol E, on behalf of the CAPRIE investigators. Reduction in the need for hospitalization for recurrent ischemic events and bleeding with clopidogrel instead for aspirin. Am Heart J 2000; 140: 67-73.

  44. Scrutinio D, Cimminiello C, Marubini E, Pitzalis MV, Di Biase M, Rizzon P, on behalf of the STAMI group. Ticlopidine versus aspirin after myocardial infarction (STAMI) trial. J Am Coll Cardiol 2001; 37: 1259-1265.

  45. Thebault JJ, Blatrix CE, Blanchard JF, Panak EA: Effects to ticlopidin, a new platelet aggregation inhibitor in man. Clin Pharmacol Ther 1975; 18: 485-491.

  46. Pengo V, Boschello M, Marzari A. Baca M, Schivazappa L, Dalla-Volta S: Adenosine diphosphate (ADP)- induced alfa granules release from platelets of native whole blood is reduced by ticlopidine but not by aspirin or dipyridamole. Thromb Haemost 1986; 56: 147-150.

  47. Savi P, Nurden P, Nurden AT: Clopidogrel: a review of its mechanism of action. Platelets 1998; 9: 251-255.

  48. CAPRIE Steering Committee. A randomised, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348: 1329-1339.

  49. Van Zanten GH, de Graaf S, Slootweg PJ: Increased platelet deposition on atherosclerotic coronary arteries. J Clin Invest 1994; 93: 615-632.

  50. Sakariassen KS, Orning L, Stormorken H: Role of ADP and thromboxanes in human thrombus formation in ex vivo models. Platelets 1997; 8: 385-390.

  51. Herbert JM, Dol F, Benat A: The antiaggregating and antithrombotic activity of clopidogrel is potentiated by aspirin in several experimental models in the rabbit. Thromb Haemost 1998; 80:512-518.

  52. Cadroy Y, Bossavy JP, Thalamas C, Sagnard L, Sakariassen K, Boneu B: Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation 2000; 101: 2823-2828.

  53. Bertrand M, Rupprecht HJ, Urban P, Gershlick A, for the CLASSICS Investigators. Double–blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting. Circulation 2000; 102: 624-629.

  54. Moshfegh K, Redonde M, Julmy F, Wuillemin W, Gebauer M, Haeberli, Meyer B: Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 2000; 36: 699-705.

  55. Bennett CL, Connors JM, Carwile JM, Moake JL, Bell WR, Tarantolo SF, et al: Thrombotic thrombocytopenic purpura associated with clopidogrel. N Engl J Med 2000; 342: 1773-1777.

  56. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.

  57. Hackett D, Davies G, Chierchia S, Maseri A: Intermittent coronary occlusion in acute myocardial infarction: value of combined thrombolytic and vasodilator therapy. N Engl J Med 1987; 317: 1055-1059.

  58. Heras M, Chesebro JH, Penny WJ, Badimon L, Fuster V: Effects of thrombin inhibition on the development of acute platelet-thrombus deposition during angioplasty in pigs: heparin versus recombinant hirudin, a specific thrombin inhibitor. Circulation 1989; 79: 657-665.

  59. Jang IK, Gold HK, Ziskind AA, Leinback RC, Fallon JT, Collen D: Prevention of platelet–rich arterial thrombosis by selective thrombin inhibition. Circulation 1990; 81: 219-225.

  60. Lee CD, Mann KG: Activation/inactivation of human coagulation factor V by plasmin. Blood 1989; 73: 185-190.

  61. Fitzgerald DJ, Catella F, Roy L, Fitzgerald GA: Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction. Circulation 1988; 77: 142-150.

  62. Kerins DM, Roy L, Fitzgerald GA, Fitzgerald DJ: Platelet and vascular function during coronary thrombolysis with tissue-type plasminogen activator. Circulation 1989; 80: 1718-1725.

  63. Vaughan DE, Van Houtte E, Declerck PJ, Van de Werf F, Collen D: Prevalence and mechanism of streptokinase-induced platelet aggregation. Circulation 1989; Suppl 11: 11-218 Abstract.

  64. Collins R, MacMahon S, Flather M, Baigent C, Remvig L, Mortensen S, et al: Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomized trials. Br Med J 1996; 313: 652-659.

  65. Simes RJ, Topol EJ, Holmes DR, White HD, Rutsch WR, Vahanian A, et al, for the GUSTO I Investigators. The link between the angiographic substudy and mortality outcomes in a large randomized trial of myocardial reperfusion: the importance of early and complete infarct artery reperfusion. Circulation 1995; 91: 1923-1928.

  66. Topol EJ, George BS, Kereiakes DJ, Stump DC, Candela RJ, Abbottsmith CW, et al, and the TAMI Study Group. A randomized controlled trial of intravenous tissue plasminógeno activator and early intravenous heparin in acute myocardial infarction. Circulation 1989; 79: 281-286.

  67. Bleich SD, Nichols TC, Schumacher RR: Effect of heparin on coronary arterial patency after thrombolysis with tissue plasminogen activator in acute myocardial infarction. Am J Cardiol 1990; 66: 1412-1417.

  68. Weitz JI, Hudoba M, Massel D, Maraganore J: Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III - independent inhibitors. J Clin lnvest 1990; 86: 385-391.

  69. Webster MWI, Chesebro JH, Fuster V: Antithrombotic therapy in acute myocardial infarction: enhancement of thrombolysis, reduction of reocclusion and prevention of thromboembolism. In Gersh BJ Rahimtolla SH, Eds. Acute myocardial infarction. New York: Elsevier Science Publishing Co Inc; 333-348, 1991.

  70. Frostfeldt G, Ahlberg G, Gustafsson G, Helmius G, Lindahl B, Nygren A, et al: Low molecular weight heparin (dalteparin) as adjuvant treatment to thrombolysis in acute myocardial infarction-a pilot study: Biochemical Markers in Acute Coronary Syndromes (BIOMACS II). J Am Coll Cardiol 1999; 33: 627-633.

  71. Fitzgerald DJ, Fitzgerald GA: Role of thrombin and thromboxane A2 I reocclusion following coronary thrombolysis with tissue-type plasminogen activator. Proc Natl Acad Sci USA 1989; 86: 7585-7589.

  72. Miletich JP, Jackson CM, Majerus PW: Interaction of coagulation factor Xa with human platelets. Proc Natl Acad Sci USA 1977; 74: 4033-4036.

  73. The Hirulog and Early Reperfusion or Occlusion (HERO) – 2 Trial investigators. Thrombin specific anticoagulation with bivalirudin versus heparin in patients receiving fibrinolytic therapy for acute myocardial infarction: the HERO – 2 randomized trial. Lancet 2001; 358: 1855-18632161.

  74. Rosing J, van Rijn JLM, Bevers EM, van Diejen G, Comfurius P, Zwaal RFA, et al: The role of activated human platelets in prothrombin and factor X activation. Blood 1985; 5: 319-332.

  75. Glick A, Kornowski R, Michowich Y: Reduction of reinfarction and angina with use of low-molecular-weight heparin therapy after streptokinase (and heparin) in acute myocardial infarction. Am J Cardiol 1996, 77: 1145-1148.

  76. Strandberg LE, Kahan T, Lundin P: Anticoagulant effects of low-molecular-weight heparin following thrombolytic therapy in acute myocardial infarction: a dose-finding study. Haemostasis 1996, 26: 247-257.

  77. Simmons ML, Krzemiñska-Pakula M, Alonso A, Goodman SG, Kali A, Loss U, et al, for the AMI-SK investigators. Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. Eur Heart J 2002; 23:1282-1290.

  78. Ribichini F, Wijns W: Acute myocardial infarction reperfusion treatment. Heart 2002; 88: 298-305.

  79. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators. A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 1997; 337: 1118-1123.

  80. Van der Werf F, Baim SD: Reperfusion for ST-segment elevation myocardial infarction. Circulation 2002; 105: 2813-2816.




2020     |     www.medigraphic.com