Eduardo Benchimol Saad
Sixth year medical student - The Federal University of Rio de Janeiro
Clearly, advances in patency rates achieved with thrombolitic agents are needed, as compared with primary PTCA in AMI. This could done with more potent and fibrin-specific drugs, with the added benefits of reducing side effects. Also important is the mode of administration, with the recent trend towards more easily administered drugs, as is the case with rPA, a mutant of rtPA, which can be administered in double bolus.
For this purpose, the GUSTO III trial was conducted, comparing rtPA( the most effective drug available ) with Rpa.
This study concluded that rPA did not diminish mortality at 30 days post AMI when compared with rtPA. The incidence of adverse effects are similar, but rPA has the advantage of double bolus administration. The equivalence of the drugs are still a matter of controversy.
Three other new thrombolytic agents were studied also in this meeting, namely Staphylokinase, TNK - tPA, and nPA. There are still no conclusions about their effect on mortality, but patency studies are very encouraging, showing reperfusion rates at 90 min. equivalent or better than rtPA. Specifically, the InTIME trial was presented, showing similar 90 min patency rates of nPA ( Lanetoplase ) when compared with rtPA. We are waiting the ongoing InTIME II trial, which has as its primary endpoint total mortality, comparing nPA with rtPA in AMI patients.
2 ) Unstable Angina / Non Q wave AMI
5 ) Atrial Fibrilation and Atrial Flutter
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