Stroke with fibrinolytic therapy

Therapeutically t-PA and urokinase are the most important drugs for fibrinolytic therapy (myocardial infarction, stroke, massive pulmonary embolism). This treatment is associated with an enhanced risk of bleeding complications. 

Zeumer H, Ereitag HJ, Zanella E, Thie A, Arning C. Local intra-arterial fibrinolytic therapy in patients with stroke urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 1993 35 159-162. 

In the prefibrinolytic era, antithrombins were principally administered to patients with STEMI to reduce the risks of pulmonary embolism, stroke, and reinfarction. The theoretical benefits of conjunctive use of unfractionated heparin (UFH) with a fibrinolytic include the possibility of augmentation of the initial lytic effect, reduction of the risk of reocclusion of an initially successfully reperfused infarct artery (with attendant risk of reinfarction), and reduction of the risk of early mural thrombus formation (28). Despite the logic of these arguments, clinical trials of conjunctive use of UFH with fibrinolytic therapy produced confusing results that continue to impact on clinical practice. Synthesis of a large body of information on studies with UFH leads to several conclusions ... 

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