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PCI post-thrombolysis
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
The Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI) trial evaluated 600 patients treated in non–PCI-equipped hospitals with half-dose reteplase, abciximab, heparin and aspirin [11]. Patients were randomised to immediate transfer for PCI (299 patients) or standard care with transfer for rescue PCI as needed (301 patients). In the immediate PCI group, the time interval from reteplase to PCI was 2.25 hours. The primary outcome, a composite of 30-day death, reinfarction or refractory ischaemia, was found to be significantly less – 4.4% for the immediate PCI group versus 10.7% for the standard care group with rescue PCI as required (P = 0.004) with no significant differences in major bleeding (3.4% vs. 2.3%, P = 0.47) or stroke (0.7% vs. 1.3%, P = 0.50).
Fibrinolytic Enzymes for Thrombolytic Therapy
Published in Peter Grunwald, Pharmaceutical Biocatalysis, 2019
Swaroop S. Kumar, Sabu Abdulhameed
Reteplase is an unglycosylated shortened single-chain deletion variant of t-PA, recombinantly produced in E. coli and having a molecular weight of 39 kDa. It consists of 355 of 527 amino acids from native t-PA; precisely 1–3 and 176–527 amino acids of t-PA. Thus reteplase includes only catalytic protease domains along with kringle 2 domain while it lacks epidermal growth factor domain, finger domain and kringle 1 domains of t-PA (Kohnert et al., 1992; Sturzebecher et al., 1992). The molecules attained enhanced half-life from 4 to 15 min as it lacks kringle 1 domain which is responsible for quick renal clearance (Martin et al., 1991b; Flemmig and Melzig, 2012). Absence of fibrin binding finger domain decreases the binding affinity of the molecule, although kringle 2 domain interacts with fibrin (Kohnert et al., 1992; Martin et al., 1991a). The mortality rate and hemorrhagic stroke for 30 days are similar for reteplase and alteplase (GUSTO III Investigators, 1997). Reteplase is commercially available as Retavase® (Centocor, Inc.) and Rapilysin® (Roche).
Antiplatelet, And Thrombolytic Agents
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
Reteplase is a second-generation recombinant tissue-type plasminogen activator that works more rapidly and may have a lower bleeding risk than alteplase. It does not bind fibrin as tightly as native tPA does so that it can diffuse more freely through the clot rather than bind only to the surface. At high concentrations, reteplase does not compete with plasminogen for fibrin-binding sites, allowing plasminogen at the site of the clot to be transformed into clot-dissolving plasmin. Reteplase does not cause allergic reactions.
Safety and efficacy of intracoronary thrombolytic agents during primary percutaneous coronary intervention for STEMI
Published in Expert Review of Cardiovascular Therapy, 2023
Natasha Kulick, Kevin A. Friede, George A. Stouffer
Other studies evaluating low-dose IC thrombolysis include STRIVE and RECOVERII. The Adjunctive, Low-dose tPA in primary PCI for STEMI (STRIVE; NCT03335839) trial is a three arm trial enrolling 200 patients with acute STEMI and a large thrombus burden to 10 mg IC alteplase, 20 mg IC alteplase or placebo once antegrade flow is established. The primary composite outcome was MACE at 180 days although this was subsequently changed to a composite endpoint of post procedural myocardial blush grade 0/1 or distal embolization. The Effect of Low-dose Intracoronary Reteplase on Myocardial Infarct Size During Primary Percutaneous Coronary Intervention (RECOVERII; NCT04571580) is randomizing 306 patients with a large anterior STEMI who present within 12 hours of symptom onset to 9 mg of reteplase, 18 mg of reteplase or placebo [64]. The drug will be delivered over 2 minutes proximal to the culprit lesion with an intracoronary catheter after wire-crossing but before thrombus aspiration or balloon dilation. The primary endpoint is infarct size assessed by late gadolinium-enhanced CMR on day 7 after PPCI.
Making a case for the right ‘-ase’ in acute ischemic stroke: alteplase, tenecteplase, and reteplase
Published in Expert Opinion on Drug Safety, 2019
Katleen Wyatt Chester, Megan Corrigan, J. Megan Schoeffler, Michelle Shah, Florence Toy, Barbara Purdon, George M. Dillon
Reteplase is approved for the treatment of acute ST-elevation myocardial infarction (STEMI) to reduce the risk of death and heart failure [14]. Reteplase is administered by IV bolus injection, and treatment should be initiated as soon as possible after the onset of AMI symptoms [14]. The recommended dose of reteplase for patients with AMI is two 10-unit (17.4 mg) bolus injections, each administered over 2 min; the second injection should be administered 30 min after the first injection (Table 1) [14]. As noted for alteplase, the use of reteplase should be carefully considered in patients whose STEMI puts them at low risk for death or heart failure because the risk of stroke (any) may outweigh the benefits of thrombolytic therapy in these patients [14].