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October 7, 1974

Urokinase and Infarction

Author Affiliations

Marshfield, Wis

JAMA. 1974;230(1):34-35. doi:10.1001/jama.1974.03240010018007

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To the Editor.—  I was interested in the fortunately brief report on the use of urokinase in the treatment of acute myocardial infarction (228:1629, 1974). Although I don't feel inclined to call a press conference, I think it might be in order to set the record straight. I am referring to Dr. M. S. Mazel's report of two cases in which urokinase was used in the treatment of acute myocardial infarction. I believe the reasoning is elusive.Only two cases were reported with pretreatment and posttreatment arteriograms, 16 and 13 days apart. Establishment of cause and effect is presumptuous, making sweeping recommendations of adoption of a new form of therapy.It is not clearly established how long myocardial muscle can be deprived of circulation before permanent changes occur. In an animal, complete myocardial death occurs 20 minutes after ligation of a major coronary. This may be somewhat longer in patients