Impaired hepatic function tests after thrombolysis for acute myocardial infarction

Acute myocardial infarction (AMI), heart attack, occurs when an acute partial or total obstruction of one or more coronary arteries results in a reduction of blood flow to the heart (myocardial ischemia). This can cause permanent damage to the cardiac muscle, which in severe cases causes death. A common therapeutic approach to AMI is the administration of thrombolytic (clot-dissolving) drugs such as streptokinase or tissue plasminogen activator. It has been reported that impairment of liver function may be a side effect of thrombolytic therapy. To study the effects of thrombolysis on liver function in more detail, 108 consecutive AMI patients were randomly assigned to receive either recombinant tissue-type plasminogen activator (r-TPA) or streptokinase intravenously. Liver function was determined by measuring bilirubin, and levels of the liver enzymes alkaline phosphatase, alanine aminotransferase, and gamma glutamyl transferase. These measurements were performed at admission, at five-day intervals, and at three-month follow-up. Thirty-two patients who did not consent to thrombolytic therapy or who were excluded from treatment for a variety of reasons were used as an untreated control group. Levels of all three liver enzymes were significantly increased during hospitalization in the patients receiving streptokinase; in the r-TPA group, only alanine aminotransferase showed any tendency to increase. All changes had normalized in both groups by the time of the three-month follow-up. Since r-TPA induced less elevation of liver enzymes than streptokinase, it should probably be the drug of choice for patients with impaired liver function who require thrombolysis. (Consumer Summary produced by Reliance Medical Information, Inc.)