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      The Difficulty of Appraisal of Streptokinase Treatment of Myocardial Infarction

      Journal of Vascular Research

      S. Karger AG

      Myocardial infarction, Thrombolysis, Streptokinase, Coronary care unit

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          Abstract

          Considerable advances have been made in clinical pharmacology of late, permitting more precise evaluation of new drugs. This must be taken into account in assessing the thrombolytic therapy of acute myocardial infarction. Clinical trials necessitate control groups, which must in volve a sufficiently large number of patients so that differences are not due to chance. To be valid, the groups must be strictly comparable. It is essential to define precisely criteria for admission and contraindications, if possible stratifying the patients, since the final evaluation must include all patients according to the treatment originally allocated. For recent myocardial infarction, it is important to compare thrombolytic therapy with the best treatment currently available, the patients being randomly allocated to these alternatives. However, it is not clear whether the best current treatment is anticoagulation, polarizing solutions (combining glucose, insulin and potassium), prophylactic antiarrhythmic drugs (procainamide, lignocaine) or β-adrenergic inhibitors (propranolol), and therefore which to use in comparison. The trend to coronary care units already has shown a reduction in mortality, perhaps necessitating evaluation of thrombolytic therapy only in such units. If thrombolysis finds a place in the management of myocardial infarction, treatment must start within the first hours following onset of symptoms. This increases the likelihood that patients diagnosed erroneously also will be treated with thrombolytic agents. Reassurance is needed that such treatment is harmless in these circumstances. Lastly, the statistical interpretation of the value of thrombolytic therapy must be regarded as a ‘two-tailed’ situation.

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          Author and article information

          Journal
          JVR
          J Vasc Res
          10.1159/issn.1018-1172
          Journal of Vascular Research
          S. Karger AG
          1018-1172
          1423-0135
          1971
          1971
          18 September 2008
          : 8
          : 1
          : 43-56
          Affiliations
          Department of Internal Medicine (Dir.: Prof. Dr. J. Vandenbroucke) ; Laboratory of Blood Coagulation (Dir.: Prof. Dr. M. Verstraete), University of Leuven, Leuven
          Article
          157859 Angiologica 1971;8:43–56
          10.1159/000157859
          © 1971 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 14
          Categories
          Paper

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