Thrombolytic therapies: The current state of affairs

Research output: Contribution to journalReview articlepeer-review

Abstract

Thrombotic occlusive diseases are manifested in several disorders that have significant morbidity and mortality, including acute myocardial infarction, pulmonary embolism, deep venous thrombosis, and cerebrovascular accidents. This review summarizes the recently published literature covering thrombolytic therapies in these diseases, with particular attention to comparisons between the fibrin-specific tissue plasminogen activators (alteplase, reteplase, and tenecteplase) and the nonfibrin-specific activators (streptokinase or urokinase plasminogen activator). These agents act to convert plasminogen to plasmin, which in turn cleaves fibrin as part of the lysis process. Fibrin-specific activators were anticipated to be more efficacious and safer than nonspecific agents in thrombolytic occlusive diseases because of their pathophysiologically restricted mechanism of action. However, the fibrin-specific activators also lyse physiological hemostatic plugs, which can result in costly adverse events. Efficacy of fibrin-specific tissue plasminogen activators has been shown to be generally equivalent, with similar mortality rates compared with non-specific agents; however, fibrin-specific agents may be associated with an increased incidence of intracerebral hemorrhage and with increased costs. Therefore, it appears that given equivalent efficacy, nonfibrin-specific activators, such as streptokinase or urokinase, may be a safer choice in many thrombotic situations.

Original languageEnglish (US)
Pages (from-to)224-232
Number of pages9
JournalJournal of Endovascular Therapy
Volume12
Issue number2
DOIs
StatePublished - Apr 1 2005

Keywords

  • Acute peripheral arterial occlusions
  • Cerebrovascular accident
  • Deep venous thrombosis
  • Fibrinogen
  • Myocardial infarction
  • Plasmin
  • Plasminogen
  • Pulmonary embolism
  • Streptokinase
  • Thrombotic occlusive disease
  • Tissue plasminogen activator
  • Urokinase

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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