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Table of Contents
Vol. 91, No. 4, 1999
Issue release date: October 1999
Section title: Coronary Care
Cardiology 1999;91:243–249
(DOI:10.1159/000006918)

Thrombolytic Therapy with Streptokinase and Tissue Plasminogen Activator in a Patient with Suspected Acute Myocardial Infarction: A Decision Analysis

Hiatt M.D.
Wake Forest University School of Medicine, Winston-Salem, N.C., USA

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Article / Publication Details

First-Page Preview
Abstract of Coronary Care

Published online: 10/25/1999

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 7

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD

Abstract

Two commonly used thrombolytic agents are streptokinase (SK) and tissue plasminogen activator (t-PA), which have different impacts on the incidence of mortality and thrombolysis-related acute intracranial hemorrhage. A decision-analytic model was developed to compare the use of SK and t-PA in the treatment of a patient with suspected acute myocardial infarction (AMI). The outcome was health-related quality of life as quantified in a measure of utility from the patient’s point of view. The model included three outcome states: death, nonfatal yet disabling stroke, and survival with no disabling stroke. The utility for disabling stroke was determined relative to the reference states of no disabling stroke (1.00) and death (0.00) by means of the time trade-off estimation technique. Probabilities were derived from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Artery trial, which revealed that although administering t-PA results in a lower percentage of deaths compared to SK, it may lead to a higher percentage of strokes. A decision tree was constructed to model the options and outcomes. The tree was analyzed by standard decision analytic techniques using SMLTREE software, and the stability of the results was examined as values of parameters were varied systematically in a sensitivity analysis. In the baseline analysis, SK yielded 0.9235, whereas t-PA yielded 0.9329. The sensitivity analysis revealed that if the probability of a disabling stroke attributable to t-PA were greater than 2.08%, SK would yield the higher expected utility. This threshold value, however, was much greater than the probability established in major trials. The administration of t-PA leads to a slightly better outcome than does the administration of SK in a patient with suspected AMI.


  

Author Contacts

Mark D. Hiatt, MD, MBA
324 Grandview Drive
Winston-Salem, NC 27104 (USA)

  

Article Information

Received: Received: April 5, 1999
Accepted: April 15, 1999
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 7, Number of References : 28

  

Publication Details

Cardiology (International Journal of Cardiovascular Medicine, Surgery andPathology)
Founded 1937 as ‘Cardiologia’ by Bruno Kisch and WilhelmLöffler

Vol. 91, No. 4, Year 1999 (Cover Date: Released October 1999)

Journal Editor: Joseph S. Alpert, Tucson, Ariz.
ISSN: 0008–6312 (print), 1421–9751 (Online)

For additional information:http://www.karger.com/journals/crd


Article / Publication Details

First-Page Preview
Abstract of Coronary Care

Published online: 10/25/1999

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 7

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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