Journal of The American College of Cardiology, 1990
In the TAMI 5 Trial 575 patients with acute myocardja~ infarction were randomized in a factorial ... more In the TAMI 5 Trial 575 patients with acute myocardja~ infarction were randomized in a factorial design to treatment with a fibrinspecific agent (t-PA-100 mg/3hrs), a nonspecific lytic agent urokinase (UK 3x108units/90mino) or the combination (COMBO-t-PA Img/kg+WK ).5xlOeunits/Shr) and acute or pre-discharge cardiac catheterization. Prospectively, standard criteria for transfusion were set for the trial at hematocrit ( ) &2 or <25 with hemodynamic instability. Bleeding camp tions dur the entire hospita! course were measured in terms of units of packed red blood cells transfused and change in hematocrit from admission to nadir ( XT). in preliminary analysis of the 453 patients treated without coronary bypass surgery* HCT did not vary by drug regimen (UKzg.9; t-PA:9.4; COMBO:g.6) or cath strategy (Acute 9.3; Predischarge 8.5). Nadir Hct by drug regimen was U BtI35 and by cath strategy was Acnte:34, Predis Similarly, no substantial differences were found in t~nsf~sion rates (22 units) by drug strategy (WK:tO%, t-PA:9%, C0MB01:12%) or by cath strategy (Acute:! 1%. Predischarge:lIO%). When surgical patients were also included, the overah bleeding rates were higher, but no differences among strategies were observed. The only catastrophic bleeding complications were irtra-cranial hemorrhages (t-PA:4, UIC2, COMBO:O); all pts died as a result. Thus, fibrin specificity does not confer an advantage with regard to bleeding r&k and judicious transfusion allows early catheterization to complished with minimal additional use of blood products. be ac-TQ ~~n~ua~e the outcome of double and triple vessel selected pts.
Journal of The American College of Cardiology, 1990
In the TAMI 5 Trial 575 patients with acute myocardja~ infarction were randomized in a factorial ... more In the TAMI 5 Trial 575 patients with acute myocardja~ infarction were randomized in a factorial design to treatment with a fibrinspecific agent (t-PA-100 mg/3hrs), a nonspecific lytic agent urokinase (UK 3x108units/90mino) or the combination (COMBO-t-PA Img/kg+WK ).5xlOeunits/Shr) and acute or pre-discharge cardiac catheterization. Prospectively, standard criteria for transfusion were set for the trial at hematocrit ( ) &2 or <25 with hemodynamic instability. Bleeding camp tions dur the entire hospita! course were measured in terms of units of packed red blood cells transfused and change in hematocrit from admission to nadir ( XT). in preliminary analysis of the 453 patients treated without coronary bypass surgery* HCT did not vary by drug regimen (UKzg.9; t-PA:9.4; COMBO:g.6) or cath strategy (Acute 9.3; Predischarge 8.5). Nadir Hct by drug regimen was U BtI35 and by cath strategy was Acnte:34, Predis Similarly, no substantial differences were found in t~nsf~sion rates (22 units) by drug strategy (WK:tO%, t-PA:9%, C0MB01:12%) or by cath strategy (Acute:! 1%. Predischarge:lIO%). When surgical patients were also included, the overah bleeding rates were higher, but no differences among strategies were observed. The only catastrophic bleeding complications were irtra-cranial hemorrhages (t-PA:4, UIC2, COMBO:O); all pts died as a result. Thus, fibrin specificity does not confer an advantage with regard to bleeding r&k and judicious transfusion allows early catheterization to complished with minimal additional use of blood products. be ac-TQ ~~n~ua~e the outcome of double and triple vessel selected pts.
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