Advances in thrombolytic therapy

Abstract

Alteplase and saruplase are more fibrin-specific thrombolytic drugs than anistreplase. These and the thrombolytic drugs of the first generation (streptokinase and urokinase) have shortcomings and limitations. The prolonged intravenous maintenance infusions have been replaced by a bolus injection, accelerated infusions, or the combined intravenous administration of thrombolytic agents. Numerous truncated alteplase or saruplase molecules have been constructed by deletion and domain substitution or hybrids made of the two molecules without gaining in thrombolytic potency. Recombinant staphylokinase and plasminogen activator from bat saliva have some interesting properties and are being investigated. Thrombus-targeted thrombolytic drugs were constructed using monoclonal antibodies against fibrin fragments or against epitopes of activated platelets. Fibrin-specific thrombolytic drugs require the concomitant use of a potent antithrombotic drug to prevent reocclusion. Whether hirudin or synthetic thrombin inhibitors are superior to heparin and whether novel antiplatelet agents, including monoclonal antibodies to platelet receptors and disintegrins, are more effective than aspirin is under clinical investigation. The place of stable analogues of prostacyclin during thrombolytic treatment is still unsettled.

In Vitro Clot Lysis as a Potential Indicator of Thrombus Resistance to Fibrinolysis – Study in Healthy Subjects and Correlation with Blood Fibrinolytic Parameters

“…Thrombolytic therapy is a well established therapy for acute myocardial infarction. Tissue plasminogen activator ([-PA) is one of the most widely used thrombolytic agents because of its clot-specificity, lack of immunogenicity and efficacy (1,2). Despite the attempts made to optimize the dosage and the duration of thrombolytic treatment with t-PA, a significant proportion of patients (7 to more than 50%) are resistant to lysis, as assessed by angiography performed within the first 90 min (1,2).…”

“…Tissue plasminogen activator ([-PA) is one of the most widely used thrombolytic agents because of its clot-specificity, lack of immunogenicity and efficacy (1,2). Despite the attempts made to optimize the dosage and the duration of thrombolytic treatment with t-PA, a significant proportion of patients (7 to more than 50%) are resistant to lysis, as assessed by angiography performed within the first 90 min (1,2). The identification of patients who may poorly respond to thrombolytic therapy would be of particular interest because it might prompt a selection of an alternative thrombolytic strategy or consideration of mechanical intervention.…”

Production and Characterisation of Anti‐Cardiac Troponin‐I Monoclonal Antibodies

“…The advent and advancement of thrombolytic therapy has significantly affected the management of patients with acute myocardial infarction (AMI) (Verstraete, 1992). The familiar triad of clinical history, ECG and serum enzyme analysis, is still of some significance in the diagnosis of MI (Willerson, 1989).…”