Sometimes, we hear people say that they feel as if their heart fails, or they are dead on their feet, or cannot move hand. All is good as long as it is a metaphor. But what if it is a clot located in a brain or heart vessel that makes itself felt, and this is about a precursory symptom of stroke or myocardial infarction? What will help protect oneself from severe complications of these diseases?
cardiovascular diseases (in Russia, more than 1.2 million people). Cardiovascular diseases are not only the major cause of total mortality, but also the cause of death of 30% of the working-age population.
Ischemic heart disease accounts for 53% of the population deaths; of this total percentage, 13% of people die of myocardial infarction. In 2015, myocardial necrosis killed approx. 63 thousand Russians.
Ischemic stroke is quite common as well: according to the National Register 2015, it was diagnosed in approx. 420 thousand Russians.
Although in 2016, health professionals managed to decrease the lethality associated with cardiovascular diseases by 12%, the death rate is still high: cardiovascular diseases account for 68.5% of all-cause mortality.
As long ago as by the end of 1950s, studies have proved that the important cardiovascular disease risk factors were the family background and age. These risk factors are non-modifiable, i.e. their effect cannot be eliminated, but they must be taken into account for singling out the patient groups with increased risk of cardiovascular diseases.
At the same time, humans can influence other factors, e.g., stop smoking, maintain normal blood pressure and blood sugar levels, lose excess weight, and, with medical assistance, monitor cholesterol levels. Such behaviors may slow down atherosclerosis progression, and decrease the risk of myocardial infarction and stroke. If the vessel wall has been significantly changed, surgical intervention with subsequent pharmacotherapy may be required.
Ischemic heart disease develops if atherosclerosis plaques start forming in the heart coronary arteries. A plaque obstructs part of the vessel lumen reducing the blood flow to a specific heart region.
If a plaque is damaged because of inflammation, mechanical abnormality, and other factors, thrombocytes and erythrocytes immediately stick to its lipid main body, and the coagulation system activates. As a result, a clot forms. It may completely block the coronary artery lumen, and the myocardial cells that used to be supplied with blood via this artery start necrotizing. Thus, myocardial infarction develops. If the clot is not damaged, and the blood flow is not restored within the first few hours, cardiac cells will die irreversibly.
It is possible to save the myocardium if percutaneous coronary intervention is performed not later than 2 hours after the symptom onset. This is a catheterization procedure to restore and maintain the arterial lumen.
In Russia, it is often impossible to provide for thrombolytic administration within the time required because of a huge territory, and underdeveloped health infrastructure. Most patients are admitted to hospitals with a critical delay, but the later the treatment is initiated the higher the risk of complications and death. However, it is possible to provide aid to patients prior to their admission to a hospital by injecting thrombolytics at the pre-hospitalization stage.
The Russian medicine is in need of thrombolytic therapy development not only in myocardial infarction but also in ischemic stroke, which is also caused by an artery occlusion, but a cerebral artery, not cardiac as in the former case. In 2015, 8,280 stroke patients received thrombolytic therapy, with approx. 21 thousand patients a year requiring this treatment.
In 2016, Boehringer Ingelheim, the world’s leading thrombolytic manufacturer, announced the start of a thrombolytic localization project at Petrovax Pharm's site in Moscow region. In August 2017, first commercial Metalyse batches were launched to the market. By 2019, a full-cycle manufacturing process will be in place for Actilyse, the company’s second innovative thrombolytic agent. Due to being manufactured locally, socially important pharmaceuticals will become readily available for Russian patients, which means that physicians will be able to inject them in the first hours of the symptom onset in a patient.
Not by coincidence, Boehringer Ingelheim chose its Russian partner. It is NPO Petrovax Pharm that
Actilyse® (alteplase) was registered in Europe in 1987, in Russia — in 1990, and for nearly 30 years of extensive use in Russia, it has remained the “gold standard” of thrombolytic therapy demonstrating its efficacy for all approved indications, i.e. acute ischemic stroke, acute myocardial infarction, and pulmonary embolism.
Metalyse® (tenecteplase) for treatment of acute myocardial infarction was registered in Russia in 2004. Russia has gained an extensive experience of Metalyse® use in delivering emergency medical care to myocardial infarction patients.
More than 100 thousand patients, including the Russians, participated in alteplase clinical trials, and more than 40 thousand — in tenecteplase clinical studies.
Currently in Russia, more than 30 thousand patients a year get a real chance for survival due to Boehringer Ingelheim advanced thrombolytics: of them, more than 20 thousand people thanks to alteplase, and approx. 10 thousand — thanks to tenecteplase.
Thus, production of vital thrombolytics in Russia will encourage a large-scale implementation of thrombolytic therapy all over the country. Not only inhabitants of large Russian cities, but also those living in small settlements will now be able to increase their chances for survival, and prevention of bad after-effects of myocardial infarction, ischemic stroke, and pulmonary embolism.