Titre du document / Document title

Can we improve on front-loaded alteplase (r-TAP)

Auteur(s) / Author(s)

AYLWARD P. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Flinders Medical Centre, Adelaide, SA, AUSTRALIE

Résumé / Abstract

The method of administration of alteplase has evoked since its introduction to clinical practice in the late 1980s. The initial dosage regimen of a graded administration of 100 mg was replaced by the front-loaded weight adjusted regimen, the efficacy of which was demonstrated in the GUSTO 1 trial. Double bolus administration was shown to achieve superior TIMI 3 patency of the infarct related artery in a small angiographic study, but the COBALT trial failed to show equivalence and indeed showed a slightly higher mortality and incidence of stroke, so cannot be recommended. Reteplase, a deletion mutant of alteplase, also showed superior efficacy in achieving coronary patency but no clinical superiority in outcomes in the 15,000 patient GUSTO 3 trial. The case of administration of reteplase, however, has some attraction as an alternative to alteplase. Trials of newer agents based on further modifications of alteplase are ongoing, but at present the front-loaded alteplase regimen remains the standard for clinical practice.

Revue / Journal Title

Australian and New Zealand journal of medicine   ISSN 0004-8291   CODEN ANZJB8 

Source / Source

Congrès
Annual Scientific Meeting of the Australian Society for Geriatric Medicine, Melbourne , AUSTRALIE (11/05/1998)
1998, vol. 28, n^o 4, pp. 489-503 (8 ref.), pp. 511-513

Langue / Language

Anglais

Editeur / Publisher

Royal Australasian College of Physicians, Sydney, AUSTRALIE  (1971-2000) (Revue)

Mots-clés anglais / English Keywords

Alteplase ; Route of administration ; Posology ; Human ; Comparative study ; Bolus injection ; Perfusion ; Australia ; New Zealand ; Oceania ;

Mots-clés français / French Keywords

Altéplase ; Voie administration ; Posologie ; Homme ; Etude comparative ; Injection bolus ; Perfusion ; Australie ; Nouvelle Zélande ; Océanie ;

Mots-clés espagnols / Spanish Keywords

Alteplasa ; Vía administración ; Posología ; Hombre ; Estudio comparativo ; Inyección bolo ; Perfusión ; Australia ; Nueva Zelandia ; Oceania ;

Localisation / Location

INIST-CNRS, Cote INIST : 6285, 35400007048052.0260