Review of Pharmacology and Physiology in Thrombolysis Interventions

Abstract

Reperfusion therapy using thrombolytic agents has been shown to be a safe and effective treatment strategy for arterial ischemia, venous thrombosis, massive pulmonary embolism, and acute stroke. Thrombolytic agents have evolved over the course of a few decades, from nonfibrin selective to fibrin-selective agents. The development and modification of these agents have resulted in improved understanding of their pharmacologic attributes, and their effects on the complex molecular events that occur during thrombolysis goal-directed therapies. The current review focuses on the physiology and pharmacology of the thrombolytic agents that have been or are currently in use for interventional thrombolysis interventions. Attention is also given to the particular role that thrombolytic agents play in the current management of peripheral vascular disease and acute stroke.

Catheter-Directed Thrombolysis in the Treatment of Acute Ischemia in Lower Extremities Is Safe and Effective, Especially with Concomitant Endovascular Treatment

“…Preferably contralateral vessel access was obtained and prior to catheter placement a diagnostic arteriogram demonstrating the level of thrombosis was performed. CDT was performed using alteplase (Actilyse, Boehringer Ingerheim, Copenhagen, Denmark) 7 ) which was infused continuously (80 mg/h) and was supplemented with a daily injection of 3500 IE Tinzaparin (Innohep, LEO Pharma Nordic, Malmö, Sweden) subcutaneously. When symptoms of improvement or deterioration were observed, angiographic control was performed in order to adjust catheter placement.…”

Computer-aided engineering of staphylokinase toward enhanced affinity and selectivity for plasmin

“…Therefore, the assay monitors mainly the fibrin-SAK interaction. Alteplase showed a significantly lower penetration rate than the control protein BSA, indicating a substantial level of binding within the fibrin network [5] , [6] , [48] . Conversely, the penetration rates of SAK-wt and SAK01 did not differ from the control.…”

Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience

“…17 Kessel and his colleagues reported that there were no significant differences in amputation-free survival between these methods. 18 Some reports, showed an increased rate of bleeding with high dose bolus technique compared with continuous infusion whereas others do not. 12 Lacing technique refers to infusion of large concentrated dose of thrombolytic agent along the length of the thrombus aiming for saturating the thrombus with the plasminogen activator before starting infusion.…”