Pulmonary embolism, thrombolytics

Therapeutic uses Originally used for the treatment of deep-vein thrombosis and serious pulmonary embolism, thrombolytic drugs are now being used with increasing frequency to treat acute myocardial infarction and peripheral arterial thrombosis and emboli, and for unclotting catheters and shunts. 

Thrombolytic Enzymes. Although atherosclerosis and the accompanying vascular wall defects are ultimately responsible for such diseases as acute pulmonary embolism, arterial occlusion, and myocardial infarction, the lack of blood flow caused by a fibrin clot directly results in tissue injury and in the clinical symptoms of these devastating diseases (54). Thrombolytic enzyme therapy removes the fibrin clot by dissolution, and has shown promise in the treatment of a number of thrombo-occlusive diseases (60). 

Thrombolytics should be considered on a case-by-case basis when pulmonary embolism is suspected. 

Goldhaber SZ. A contemporary approach to thrombolytic therapy for pulmonary embolism. Vase Med 2000 5 115-123. 

Goldhaber SZ, Bounameaux H. Thrombolytic therapy in pulmonary embolism. Semin Vase Med. 2001 1 213-220. 

Konstantinides S. Should thrombolytic therapy be used in patients with pulmonary embolism Am J Cardiovasc Drugs. 2004 4 69-74. 

Urokinase is also a thrombolytic agent, used for treating pulmonary embolism. Two variants of this protease have already been isolated one of 54 kDa and another of 33 kDa, both displaying proteolytic activity over plasminogen. Until recently, the only exogenous source for this enzyme was urine. However, in 2002 the product called Abbokinase, which is produced in neonatal kidney tissue culture, was approved in the USA. 

Thrombolytic therapy with streptokinase or urokinase i.v. may be used for life-threatening thrombosis, e.g. major pulmonary embolism with compromised haemodynamics (see p. 580). 

Pulmonary embolism. Thrombolysis is superior to heparin at relieving obstructed veins demonstrated radiologically. While a reduction in mortality is thus implied, the numbers of cases reported in clinical trials of thrombolytics have been insufficient to... 

Ashton RW, Daniels CE, Ryu JH. Thrombolytic therapy in patients with submassive pulmonary embolism. N Engl J Med 2003 348 357. 

Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism A comprehensive review of current evidence. Chest 1999 115 1695-1707. 

Thrombolytics include tissue plasminogen activator (tPA, recombinant) and streptokinase (bacterial). They are used intravenously for short-term emergency management of coronary thromboses in myocardial infarction (MI), deep venous thrombosis, pulmonary embolism, and ischemic stroke (tPA). 

Thrombolytic human recombinant tissue plasminogen activator. Used in acute Ml (to recanalize the occluded coronary), pulmonary embolism, stroke. Tox bleeding. 

Interest in thrombolytic therapy for acute ischemic stroke re-emerged with reports of successful thrombolysis for arterial thrombosis in the peripheral vascular system. Local lA infusion was found to have higher rates of recanalization compared with systemic IV delivery of thrombolytics without increased levels of hemorrhagic complications IV use of UK and SK was found to provide clinical benefit in patients with pulmonary embolism [5, 6]. In the early 1980s, lA infusion of UK or SK for acute MI was shown to be highly effective [5, 6]. At the same time, technical advances in endovascnlar microcatheter and microguidewire design made access to the intracranial vessels safer... 

Capstick T, Henry M T (2005). Efficacy of thrombolytic agents in the treatment of pulmonary embolism. Euro. Respirat. J. 26(5) 864-874. 

Thrombolytics, on the other hand, are drugs needed to dissolve the newly formed thrombi in conditions such as DVT, acute pulmonary embolism, or myocardial infarction. Because of their lack of specificity, however, these agents actually may cause internal bleeding and, thus, are contraindicated with the use of many other therapeutic agents. 

Early application of reperfusion therapy with thrombolytic agents has significantly improved the outcomes of acute myocardial infarction and other conditions, such as pulmonary embolism, DVT, arterial thrombosis, acute thrombosis of retinal vessel, extensive coronary emboli, and peripheral vascular thromboembolism (124). 

Thrombolytics are also used for pulmonary embolism, deep vein thrombosis, and noncoronary arterial occlusion from an acute thromboembolism. 

Tissue plasminogen activator tPA alteplase (Activase) 59.04 Plasma volume (0.05 Lkg- ) 0.083 (initial) IV bolus injection followed by IV infusion (1.0 in both) Thrombolytic agent used in acute myocardial infarction, acute ischemic stroke and pulmonary embolism... 

A therapeutic regimen that usually controls haemorrhage involves discontinuation of enzyme treatment, administration of e-aminocaproic acid in a dose of 100 mg/kg body weight by slow intravenous injection, and blood transfusion (F). It is important to remember that the risk of thrombolytic therapy is not only haemorrhage but also thromboembolism. In one group of 93 patients with deep vein thrombosis treated by streptokinase infusion, a patient died of pulmonary embolism 8% of the patients in all experienced a less serious embolism (11 ). Eight cases of embolism, 4 of them with a fatal outcome, were seen in a series of 80 treated with streptokinase (18 ). 

Suigery or thrombolytic therapy for massive pulmonary embolism. 

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