RESUMEN
OBJECTIVE: To determine in nonresearch, general medical practice conditions the comparative incidence and types of bleeding complications after the use of streptokinase (SK) and r-alteplase (recombinant tissue plasminogen activator, rt-PA) to treat acute myocardial infarction (AMI). DESIGN: Retrospective medical record review of concurrently treated patients (96-hour observation posttreatment) in 32 participating hospitals in the US. MAIN OUTCOME MEASURES: The medical record description of all bleeding events regarding the body site affected, changes in hemoglobin concentrations, blood products administered, and clinical outcome (permanent sequelae or death). Bleeding severity was determined by defined criteria. CONTROL DATA: Comorbidity and concomitant medications (e.g., aspirin, heparin, warfarin) likely to predispose or contribute to bleeding events were analyzed. DATA ANALYSIS: Logistic regression analysis. RESULTS: Data from 419 patients who received rt-PA and 207 who received SK were evaluated. In the 96-hour period after initiation of thrombolytic therapy, 30.5 and 31.9 percent of rt-PA and SK patients, respectively, experienced one or more bleeding events (crude risk ratio [CRR] = 1.04; 95 percent confidence interval [CI] 0.91-1.14; p = 0.73). In the first 24-hour period, 21.5 percent of rt-PA and 15.9 percent of SK patients experienced bleeding events (CRR = 0.74; 95 percent CI 0.42-1.15; p = 0.08). The leading types of bleeding and percents of all patients affected were: perivascular access site (18.4 percent), gastrointestinal (6.4 percent), skin/soft tissue/muscle (5.0 percent), urinary (3.4 percent), pulmonary (2.2 percent), systemic (1.9 percent), and oral (1.4 percent). Intracranial bleeding occurred in 4 rt-PA and 2 SK patients; 4 of these patients died. Events deemed clinically significant occurred in 15 rt-PA and 9 SK patients (3.8 percent of all patients). Ten patients likely died from these events, 6 within the first 24 hours. Three rt-PA patients and 1 who received SK (0.6 percent) died of cerebrovascular events within the first 24 hours. After controlling for demographic factors and therapeutic variables, using logistic regression analyses, no thrombolytic-related differences were found in the incidence or severity of bleeding following use of the two thrombolytics. CONCLUSIONS: These clinical data do not support a theoretical advantage of rt-PA to cause less bleeding propensity than SK.
Asunto(s)
Hemorragia/inducido químicamente , Infarto del Miocardio/tratamiento farmacológico , Estreptoquinasa/efectos adversos , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Hemorragia/epidemiología , Humanos , North Carolina/epidemiología , Estudios Retrospectivos , Estreptoquinasa/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéuticoAsunto(s)
Certificación , Quimioterapia/normas , Farmacia/normas , Sociedades Farmacéuticas , Estados UnidosRESUMEN
Loratadine is an addition to the class of nonsedating antihistamines which includes terfenadine, astemizole, and acrivastine. Loratadine is chemically related to the tricyclic antidepressants. Animal data have shown that insignificant amounts of loratadine enter the brain, and it has a threefold greater affinity for peripheral as compared with central histamine 1-receptors. Loratadine has one main metabolite, descarbethoxyloratadine, which is four times more active than the parent drug. Loratadine reaches peak plasma concentration in 1-2 hours; the metabolite does so in 3-4 hours. Their respective elimination half-lives are about 10 and 20 hours. Onset of action is within 1 hour and duration is at least 24 hours. Once-daily dosing is recommended. Generally, loratadine is as efficacious as existing antihistamines in relieving symptoms of allergic rhinitis, urticaria, and in suppressing wheal formation. Reports of sedation and other adverse reactions are no more frequent than found with placebo. Tachyphylaxis has not been noted in humans, and there is minimal potential for drug interactions based on animal data. Loratadine and terfenadine have comparable therapeutic applications. Both have shown minimal adverse effects, but loratadine has a quicker onset and longer duration of action. These two agents are useful for acute allergic reactions. In contrast, astemizole has an onset of action of several days and is most useful for prophylactic treatment of seasonal allergies.