IMR Press / RCM / Volume 3 / Issue S2 / pii/1561516729741-937509841

Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.

Open Access Review
Pharmacologic and Clinical Characteristics of Thrombolytic Agents
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1 Section of Hematology and Coagulation Medicine and Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
2020 Center for Hypertension and Cardiovascular Medicine, Lenox Hill Hospital, New York, NY
Rev. Cardiovasc. Med. 2002, 3(S2), 25–33;
Published: 20 February 2002
Abstract
Arterial and venous thromboembolic events, including myocardial infarction, ischemic stroke, peripheral arterial thrombosis, deep venous thrombosis, and pulmonary embolism are common and potentially life-, organ-, and limb-threatening vascular diseases. Anticoagulant therapy is recommended in these settings to prevent further thrombosis pending gradual clearance of the thrombotic occlusion by the endogenous fibrinolytic system. Recognition of the importance of the fibrinolytic system in thrombus resolution has resulted in the development of pharmacologic fibrinolytic (thrombolytic) agents to facilitate rapid restoration of vascular patency. Several plasminogen activator (PA) thrombolytic agents with different pharmacokinetic and pharmacodynamic properties have been developed to treat thrombotic disease. Newer PAs have been developed as “fibrin-specific,” bolus-administration drugs to primarily treat acute coronary syndromes. Continuous infusions of these fibrin-specific PAs have become popular for the lysis of relatively larger peripheral vascular thromboses. Loss of coveted fibrin specificity due to the generation of fragment X during the continuous infusion of newer tissue-type plasminogen activator–based PAs may result in an increased risk of bleeding, including intracranial hemorrhage. Currently available data fail to provide compelling evidence that newer PAs offer significantly greater efficacy and safety than well-established agents like urokinase when used to treat peripheral vascular thrombosis.
Keywords
Fibrin
Fragment X
Thrombosis
Thrombolysis
Plasminogen activator
Fibrinolysis
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