Can we improve on front-loaded alteplase (r-TPA)?
Author(s): Aylward P Affiliation(s): Flinders Medical Centre, Adelaide, SA. Publication date & source: 1998-08, Aust N Z J Med., 28(4):511-3. Publication type: Clinical Trial; Randomized Controlled Trial The method of administration of alteplase has evolved since its introduction to clinical practice in the late 1980s. The initial dosage regimen of a graded administration of 100 mg was replaced by the front-loaded weight adjusted regimen, the efficacy of which was demonstrated in the GUSTO 1 trial. Double bolus administration was shown to achieve superior TIMI 3 patency of the infarct related artery in a small angiographic study, but the COBALT trial failed to show equivalence and indeed showed a slightly higher mortality and incidence of stroke, so cannot be recommended. Reteplase, a deletion mutant of alteplase, also showed superior efficacy in achieving coronary patency but no clinical superiority in outcomes in the 15,000 patient GUSTO 3 trial. The case of administration of retepla
