Plasmin Inhibitors and Fibrinogen Breakdown During the Initial Phase of Thrombolytic Treatment - The Problem of the α2-Antiplasmin Determination

Abstract

SummaryDuring the first 3 hr of thrombolytic treatment with porcine plasmin (p-PL) or streptokinase (SK) a rapid decrease of clottable fibrinogen with generation of large amounts of fibrin(-ogen) degradation products (FDP) are found. α2-antiplasmin (α2AP) is rapidly neutralized. Whereas in patients treated with SK more than half of the original plasminogen was consumed, its level remained unchanged during p-PL infusion. When α2AP reaches values below some 20%, spontaneous amidolytic activity towards S-2251 representing either PL-α2-macroglobulin- or SK-plasminogen-complex activity appears. This activity has to be considered in the α2AP assay in order to avoid underestimation of this inhibitor.

High-Dose Systemic Streptokinase and Acylated Streptokinase-Plasminogen Complex (BRL 26921) in Acute Myocardial Infarction: Alterations of the Fibrinolytic System and Clearance of Fibrinolytic Activity

“…Recently, Verstraete et al [10,11] could demonstrate that even tissue-type plasminogen activator de creases the circulating fibrinogen level when applied in high dosages for treatment of AMI. However, the decrease of fibrinogen and cu-antiplasmin may be overestimated in the test systems applied in our studies [29], From our studies we conclude that BRL 26921 is not superior to high-dose SK bolus injection with regard to arterial hypotension or fibrin specificity. However, the signifi cantly longer half-life of BRL 26921 appears to be an advantage when a single bolus injec tion is the desired form of treatment.…”

Thrombolytic Activity of Defibrotide Against Old Venous Thrombi

“…The clinical potential for rapidly dissolving thrombi by thrombolytic therapy is considerable because restoration of the blood flow can rescue the jeopardized district served by the occluded vessel. Deep vein thrombosis, 8 myocardial infarction, 9 arterial occlusion, 8 acute pulmonary embolism, 10 and occlusion of retinal vessels 11 all require dissolution of the occluding thrombus.…”