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European Heart Journal 2003 24(18):1699; doi:10.1016/S0195-668X(03)00370-1
Copyright © 2003 by the European Society of Cardiology.
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Letters to the Editor

Reply: Lack of a Rationale for the Task Force recommendation regarding Re-administration of Streptokinase

F. Van der Werf, Chairman, ESC Task Force on the Management of Acute Myocardial Infarction on behalf of the Task Force members

E-mail address: Frans.VandeWerf{at}uz.kuleuven.ac.be

Dr Thimme questions the task force recommendation not to re-administer streptokinase (or anistreplase) in case of re-infarction.

Re-infarction due to re-occlusion of a previously recanalized coronary artery or to occlusion of another coronary vessel is a serious condition associated with a high morbidity and mortality. Therefore,optimal reperfusion therapy should be offered as soon as possible to these patients. If primary angioplasty is not available re-administration of lytic therapy is the only alternative. If a patient already received streptokinase or anistreplase at the time of the first infarction it is likely that neutralizing antibodies have developed which may reduce the efficacy for clot lysis after a second administration.

There is uncertainty regarding theincidence and the duration of the presence of these antibodies and large studies of the effect on clinical outcomes after re-administration are lacking. Antibodies have been detected up to 7.5 years after the first administration of streptokinase and there is no evidence that these antibodies may disappear completely.1Indeed, Squire et al. conclude that ‘there is as yet no evidence of a time limit beyond which administration of streptokinase on a second occasion can be regarded as safe and likely to be effective’.1In view of this, the Task Force recommends not to re-administer streptokinase or anistreplase at any time after the first administration.2More effective reperfusion therapies such as primaryangioplasty or the administration of a non-immunogenic fibrin-specific lytic agent should be offered to these high-risk patients.

References

  1. Squire IB, Lawley W, Fletcher S et al. Humoral and cellular responses up to 7.5 years after administration of streptokinase for acute myocardial infarction. Eur Heart J. 1999;20:1245–1252.[Abstract/Free Full Text]
  2. Van de Werf F, Ardissino D, Betriu A et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2003;24:28–66.[Free Full Text]

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