Thrombolytic therapy systemic

More recently, thrombolytic therapy was reported in 106 patients as part of the TEMPiS system in Bavaria, Germany. The network consists of two comprehensive and 12 regional centers connected by around-the-clock telemedicine support for stroke care. In the first year following intervention, the number of patients treated with rt-PA increased to 86 patients (2% of all patients admitted with stroke), compared to 10 patients treated in the year preceding intervention. The rate of symptomatic hemorrhage was 8.5%, similar to the NINDS trial. " ... 

The hbrinolytic system (Fig. 22.2) is involved in restricting clot propagation in the blood and in the removal of fibrin as wounds heal. Treatment of patients with hbrinolytic (thrombolytic) drugs that activate the hbrinolytic system is not a substitute for the anticoagulant drugs. The purpose of thrombolytic therapy is rapid lysis of already formed clots. 

Assays to monitor the fibrinolytic system have been recommended to help monitor disseminated intravascular coagulation, thrombolytic therapy, and oncogenic transformation. (F6, H9). 

Most cases of CRVO result from the formation of a thrombus at or just posterior to the lamina cribrosa (6). Systemic thrombolytic therapy was first attempted with anticoagulants in 1938. Costen et al. (41) described one case treated within seven hours of onset who had visual acuity improve from 20/200 to 20/30 over a period of 30 minutes due to presumed lysis of the thrombus, with venous filling time improving from 34.6 to 23.3 seconds on repeated fluorescein angiography. 

To bypass the potential fatal side effects of systemically applied thrombolytic therapy, thrombolytic agents have been delivered locally into the vitreous. Elman et al. (46) reported on a retrospective series of nine eyes treated with 100 pg (0.2 mL) of intravitreal tPA followed by paracentesis. At six months of follow-up there were no adverse events, and four of the nine eyes had improved by at least three lines of visual acuity. However, two eyes sustained a loss of six or more lines. None of the four cases deemed ischemic at baseline improved beyond 20/200. In a similar series, Glacet-Bernard et al. (47) reported on 15 patients with CRVO of 1 to 21-day duration (mean of eight days) treated with intravitreal tPA. Eight of 15 patients had a baseline visual acuity of 20/50 or better. Of those patients available for the eight-month follow-up, visual acuity increased in five, remained unchanged in five, and decreased in four. Six of 15 patients developed an increased amount of intraretinal hemorrhage. The results were deemed to be no better than the natural history. 

Kent DM, Hill MD, Ruthazer R et al (2005) Chnical-CT mismatch and the response to systemic thrombolytic therapy in acute ischemic stroke. Stroke 36 1695-1699... 

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... 

Hodgson J (1994) The changing bulk biocatalyst market. Biotechnol 12 789-790 Hoffmeister HM, Szabo S, Kastner C et al. (1998) Thrombolytic therapy in acute myocardial infarction comparison of procoagulant effects of streptokinase and alteplase regimens with focus on the kallikrein system and plasmin. Circulation 98 2527-2533 Hoondtil G, liwari R, Dahiya N et al. (2002) Microbitil tilkaline pectinases and their industrial appUcations areview. J Appl Microbiol Biotechnol 59(4-5) 409 18 Hudson EP, Eppler RK, Clark DS (2005) Biocatalysis in semi-aqueous and nearly anhydrous conditions. Curr Opin Biotechnol 16 637-643... 

The clinical response to intravenous thrombolytic therapy in patients with acute myocardial infarction is often limited by failure to reperfuse the occluded coronary artery, despite evidence of a systemic lytic effect . Even in... 

Cardiovascular A meta-analysis and systemic review were performed to ascertain the relationship between prior warfarin use with subtherapeutic international normalized ratio (INR) and outcome after intravenous or intraarterial thrombolytic therapy in acute ischaemic stroke patients The outcomes were symptomatic intracranial haemorrhage, modified Rankin scale score and mortality. The risk of symptomatic intracranial haemorrhage after thrombolytic therapy was increased in patients using warfarin with subtherapeutic INR levels. However, there was no association between prior warfarin therapy and worsened fxmctional outcome or all-cause death. 

Antithrombin inhibits the activity of factors Ka, Xa, Xlla, and thrombin (Ila). It also inhibits thrombin-induced activation offactors V and VIII. UFH prevents the growth and propagation of a formed thrombus and allows the patient s own thrombolytic system to degrade the clot. Contrainchcations to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe hver chsease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

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