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EDITOR Analysis of the causes of the low rate (21%) of thrombolysis for acute myocardial infarction in England and Wales described by Mayor would be interesting.1 In Cuba thrombolysis with home manufactured recombinant streptokinase has been widespread since 1993. When this procedure was introduced nationwide, the overall proportion of patients receiving treatment was a little above 30%.
The main reason why thrombolysis was not given was largely because patients arrived at hospital more than 12 hours after the onset of symptoms. Other causes were non-ST elevation and contraindications for thrombolysis, such as possible causes of bleeding.2 The management system for patients has, however, become more efficient, with patients arriving earlier. Also doctors in emergency departments are more acquainted with the product, so currently the rate of thrombolysis is around 50% nationwide and even 70% in some units.
The report also says that streptokinase should not be given twice because of the formation of anti-streptokinase antibodies. We found that almost all patients had low titres of anti-streptokinase antibodies before thrombolysis; they increased rapidly after treatment but then started to fall.3 After six months the average anti-streptokinase titre was roughly still enough to neutralise the thrombolytic activity in plasma achieved with the 1.5 million unit dose. After one year the titres had almost returned to pretreatment values. Given these data, we think that streptokinase can be given again after a case by case analysis of risks and benefits six months after the first administration and surely after one year.
Pedro A Lopez-Saura, head of clinical trials.
Centre for Biological Research, PO Box 6162, CP 10600, Havana, Cuba lopez.saura@cigb.edu.cu
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