COMPARISON OF RETEPLASE DOUBLE-BOLUS ADMINISTRATION WITH STREPTOKINASE IN ACUTE MYOCARDIAL INFARCTION Original Article MIRVETE RAMA 1 , MIRELA MIRAÇI 2 , ELA PETRELA 3 , LEDJAN MALAJ 4 1 Pharmaceutical service “Mother Teresa” Hospital, Tirana, 2,4 Medicine University, Faculty of Pharmacy, Tirana, 3 Received: 02 Mar 2015 Revised and Accepted: 01 Apr 2015 Medicine University, Public Health Faculty, Tirana Email: rama-mirvete@live.com ABSTRACT Objective: To evaluate the thrombolytic treatment in acute myocardial infarction (AMI) and to compare the costs and the effectiveness of Reteplase double-bolus vs Streptokinase in our clinic, to compare this data with other studies. Methods: Two thrombolytic treatments were compared; Reteplase and Streptokinase in AMI by following the patients during hospital stay and at certain periods of time of 6 months, 12 months and 24 months. Differences between the two groups (streptokinase and reteplase) for discrete variables were performed by the Student test for two samples and Hi-square test. Data analysis was performed with SPSS statistical package, version 18 Results: The analysis showed no significant differences between the treatments regarding the effectiveness. After 6 months, 12 months and 24 months observation, the survival rate was 96.4% for reteplase group and 96.9% for streptokinase group. The mean age was 64.29 years for reteplase group and 56.03 years for streptokinase group (p=0.001). Hospitalization in reteplase group was at an average of 13.04days, and in streptokinase group was at an average of 17.79days (p=0.01) Cost in each respective group was 90184.90 Lek (646€) and 54148.63 Lek (388€). The difference is 36036.27 Lek or 258€ (p=0.001). Conclusion: Both thrombolytics (reteplase and streptokinase) have similar effectiveness in treatment of Acute Myocardial Infarction. Reteplase is an effective drug in the treatment of clinically Acute Myocardial Infarction, but the cost of reteplase is higher than streptokinase. It is safe, easily applied and it will be a useful addition to the valid list of thrombolytic drugs. Keywords: Cardiovascular disease, Acute myocardial infarction, Thrombolytics, Tissue plasminogen activator (t-PA), Reteplase, Streptokinase, Cost-effectiveness, Lek= Albanian money. INTRODUCTION Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, caused by the complete occlusion of a coronary artery with thrombus [1]. The thrombus occurs at the site of a plaque which has ruptured, exposing its inner core and thus promoting thrombus formation. The goals of therapy in acute MI are the expedient restoration of normal coronary blood flow and the maximum salvage of functional myocardium. These goals can be met by a number of medical interventions and adjunctive therapies. The primary obstacles to achieving these goals are the patient's failure to recognize MI symptoms quickly and the delay in seeking medical attention. When patients present themselves at the hospital, there are a variety of interventions to achieve treatment goals [2]. Early treatment aims to reduce the extent of myocardial damage. As the myocardium is damaged by a diminished oxygen supply due to the obstructed coronary artery, infarct size can be reduced in two ways: • Dissolution of the thrombus to restore coronary blood flow • Decreasing myocardial oxygen consumption Thrombolytic therapy has been a major advance in the management of acute myocardial infarction. Thrombolytic therapy works by lysing infarct artery thrombs and achieving reperfusion, thereby reducing infarct size, preserving left ventricular function, and improving survival[3]. These drugs are most effective if administered immediately after infarct has been determined. The advantage of administration is highest within the first sixty minutes after a thrombotic event, but may extend up to six hours after the start of symptoms [4]. These drugs are often administered in combination with anticoagulant drugs such as intravenous heparin or low molecular weight heparin, for synergistic antithrombotic effects and secondary prevention. Streptokinase and alteplase are established therapies in acute myocardial infarction. Reteplase is a new thrombolytic agent that can be given as a double bolus [5]. The ‘first generation’ thrombolytics had clinical disadvantages such as low specificity for fibrin, increased risk of allergic reactions (in particular with streptokinase) and short half-life. Newer thrombolytic agents such as reteplase and tenecteplase have been developed with potential advantages that include: prolonged half-life, increased fibrin specificity and increased resistance to inhibition by plasminogen activators. However, these laboratory-measured advantages may not translate into measurable clinical benefits [6]. It was proved that there is no significant difference between reteplase and streptokinase: reteplase reduced absolute 35-day mortality by 0.51% (NS, 95%CI 0.96% to 1.98%). At the lower extreme therefore, this fits within the definition of equivalence and therefore it may be said that reteplase is no worse than streptokinase INJECT study [7]. Although clear differences between thrombolytic agents are evident in the speed with which the agents achieve reperfusion, the similar survival rates in these previous trials suggested that factors other than rapid or sustained coronary reperfusion might be important in reducing mortality [8]. Reteplase produced rapid and effective coronary artery thrombolysis in a number of dose-finding and comparative studies . Double-bolus administration of reteplase 10U+10U produced International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 7, Issue 6, 2015 Innovare Academic Sciences