| The role of thrombolytic therapy in surgical practice. | |
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MedLine Citation:
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PMID: 2655813 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The ability of streptokinase and urokinase to lyse intravascular fibrin-based clots is firmly established. However, there is a lack of enthusiasm for these agents because of serious haemorrhagic complications and a lack of controlled randomized studies indicating their efficacy. Thrombolytic therapy is suitable in only 15 per cent of patients with acute deep venous thrombosis. It restores the venous circulation to normal in up to 95 per cent of these patients if therapy is instituted within 5 days of the onset of symptoms. These patients have significantly fewer symptoms on follow-up than patients treated with heparin although the ability of thrombolytic therapy to preserve venous valvular function and to prevent the post-phlebitic syndrome is now in question. Thrombolytic therapy is as effective as heparin in preventing pulmonary embolism and may be superior in its treatment. Pulmonary haemodynamics are rapidly improved, diffusion capacity is restored and, although the evidence is inconclusive, long-term pulmonary hypertension may be prevented. Although the mortality rate is not decreased, controlled studies show that thrombolytic therapy may be beneficial in massive pulmonary embolism with clinical shock. Thrombolytic therapy is indicated for acute arterial and acute bypass graft occlusion when the surgical alternative is associated with a higher morbidity and mortality. Partial thrombolysis is achieved in up to 90 per cent of cases and the need for further therapeutic intervention is eliminated in one-third of the patients treated. New thrombolytic agents with greater specificity and potentially greater efficacy and fewer complications are being developed. Tissue plasminogen activator has been successfully used. Prourokinase, fibrin-seeking urokinase and acetylated streptokinase-plasminogen complex may expand the role of thrombolytic therapy in surgical practice. |
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Authors:
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K T Moran; E R Jewell; A V Persson |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: The British journal of surgery Volume: 76 ISSN: 0007-1323 ISO Abbreviation: Br J Surg Publication Date: 1989 Mar |
Date Detail:
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Created Date: 1989-07-13 Completed Date: 1989-07-13 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0372553 Medline TA: Br J Surg Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 298-304 Citation Subset: AIM; IM |
Affiliation:
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Section of Peripheral Vascular Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Arterial Occlusive Diseases
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drug therapy Blood Coagulation Fibrinolysis Fibrinolytic Agents / therapeutic use* Humans Pulmonary Embolism / drug therapy Thrombophlebitis / drug therapy |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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