Urokinase therapy in the early stage of acute myocardial infarction.

Urokinase therapy in the treatment of myocardial infarction has been clinically tested with the intent of using its thrombolytic properties to dissolive the embolism and thus prevent any necrotizing effects on the heart muscle. Howeve, during these clinical trials both proper dosage and application method have remained controversial, especially since the therapeutic results have fallen short of expectations. Another point that must be kept in mind is the time factor. If urokinase therapy is not initiated within 5 to 6 hours after the heart attack, since the heart muscle will begin to necrotize, therapy after that point becomes meaningless. A final vital point to keep in mind during urokinase thrapy is medication selection. Urokinase comes in two forms: high molecular (molecular weight 54, 000) and low molecular types. If we exclude manufacturers of other protein-containing medications from consideration, in Japan there are only two urokinase manufacturers, namely, Kowa Shinyayu Co. Ltd. and Fujisawa Yukuhin Co. Ltd. More than 75 % of the urokinase produced by Kowa Shinyaku is of the high molecular type. When the effectiveness of urokinase therapy becomes a matter of debate, this particular drug displays its therapeutic effectiveness quite convincingly. In our report, we also tested the product of Fujisawa Yakuhin on some cases but Kowa Shinyaku Co. Ltd's medication proved clearly to be superior in its results. Since the fall of 1977, we have administered urokinase therapy to 12 patients who suffered acute myocardial infarction. During the observation period, 4 cases experienced reinfarcts and one patient died. Exitus occurred in case 8 who had been transfarred from another physician on the occasion of her second attack. The 11 remaining cases have recovered and are leading normal lives as of November 9, 1980. 109