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Hamostaseologie 2008; 28(05): 428-437
DOI: 10.1055/s-0037-1617189
Hämostaseologie
Schattauer GmbH

Fibrinolytische Therapie

Fibrinolytic therapy
J. Beyer
1   University Clinic “Carl Gustav Carus”, Division of Vascular Medicine, Technical University Dresden
,
S. Schellong
1   University Clinic “Carl Gustav Carus”, Division of Vascular Medicine, Technical University Dresden
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
29. Dezember 2017 (online)

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Zusammenfassung

Die fibrinolytische Therapie ist unverändert ein zentraler Therapieansatz bei akuten Verschlüssen verschiedener Gefäßregionen; allerdings ist vor dem Beginn einer Lysetherapie eine evidenzbasierte sorgfältige Risiko/Nutzen-Abwägung unumgänglich. Dieser Beitrag stellt die gebräuchlichen Fibrinolytika sowie Datenlage und die aktuellen Empfehlungen für Lysetherapie in den wichtigsten Gefäßregionen vor.

Summary

Fibrinolytic therapy still is a keystone in the therapeutic approach of acute occlusion in different vascular regions. However, before starting fibrinolytic therapy an evidencebased risk assessment is necessary. This article presents the most common fibrinolytic agents as well as evidences and recommendations for fibrinolytic therapy of different vascular regions.

Schlüsselwörter

Fibrinolysetherapie - akuter Gefäßverschluss - Blutungen - Komplikationen

Keywords

Fibrinolytic therapy - acute vascular occlusion - bleeding - complications
 

  • Literatur

  • 1 Agnelli G, Goldhaber SZ. Thrombolysis for treatment of venous thrombembolism. In: Oudkerk M, van Beek EJR, ten Cate JW. Pulmonary embolism. Berlin: Blackwell Science; 1999: 364-81.
    Google Scholar
  • 2 Alber GW, Amarenco P, Easton JD. et al. Antithrombotic and thrombolytic therapy for ischemic stroke. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy CHEST 2004; 126: 483S-512S.
    PubMedGoogle Scholar
  • 3 Anderson DR, Levine MN. Thrombolytic therapy for the treatment of acute pulmonary embolism. Can Med Assoc J 1992; 146: 1317-24.
    PubMedGoogle Scholar
  • 4 Assessment of the Safety and Efficacy of a New Thrombolytic Investigators.. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double- blind randomised trial. Lancet 1999; 354: 716-22.
    CrossrefPubMedGoogle Scholar
  • 5 Binbrek A, Rao N, Absher PM. et al. The relative rapidity of recanalization induced by recombinant tissue-type plasminogen activator (r-tPA) and TNK-tPA, assessed with enzymatic methods. Coron Artery Dis 2000; 86: 263-8.
    PubMedGoogle Scholar
  • 6 Büller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thrombembolic disease. Chest 2004; 126: 401S-428S.
    CrossrefPubMedGoogle Scholar
  • 7 Burkart DJ, Borsa JJ, Anthony JP. et al. Thrombolysis of occluded peripheral arteries and veins with tenecteplase: a pilot study. J Vasc Interv Radiol 2002; 13: 1099-102.
    CrossrefPubMedGoogle Scholar
  • 8 Cannon CP, McCabe CH, Diver DJ. et al. Comparison of front-loaded recombinant tissue-type plasminogen activator, anistreplase and combination thrombolytic therapy for acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) 4 trial. J Am Coll Cardiol 1994; 24: 1602-10.
    CrossrefPubMedGoogle Scholar
  • 9 Clagett CP, Sobel M, Jackson MR. et al. Antithrombotic therapy in peripheral arterial occlusive disease. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 609S-26S.
    CrossrefPubMedGoogle Scholar
  • 10 Collaborative Group.. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2 (Second International Study of Infarct Survival). Lancet 1988; 2: 349-60.
    PubMedGoogle Scholar
  • 11 Cornu C, Boutitie F, Candelise L. et al. Streptokinase in acute ischemic stroke: an individual patient data meta-analysis: The Thrombolysis in Acute Stroke Pooling Project. Stroke 2000; 31: 1555-60.
    CrossrefPubMedGoogle Scholar
  • 12 Dalen JE, Alpert JS, Hirsch J. Thrombolytic therapy for pulmonary embolism: Is it effective?. Is it safe? When is it indicated? Arch Intern Med 1997; 157: 2550-6.
    PubMedGoogle Scholar
  • 13 Dalla-Volta S, Palla A, Santolicandro A. et al. PAIMS-2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study. J Am Coll Cardiol 1992; 20: 520-6.
    CrossrefPubMedGoogle Scholar
  • 14 Del Zoppo GJ, Higashida RT, Furlan AJ. et al. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct delivery in acute middle cerebral artery stroke. Stroke 1998; 29: 4-11.
    CrossrefPubMedGoogle Scholar
  • 15 Eagle KA, Goodman SG, Avezum A. et al. GRACE Investigators. Practice variation and missed opportunities for reperfusion in ST-segment- elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 2002; 359: 373-7.
    CrossrefPubMedGoogle Scholar
  • 16 Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group.. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994; 343: 311-22.
    CrossrefPubMedGoogle Scholar
  • 17 Furlan A, Higashida R, Wechsler L. et al. Intra-arterial prourokinase for acute ischemic stroke: The PROACT II study; a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999; 282: 2003-11.
    CrossrefPubMedGoogle Scholar
  • 18 Goldhaber SZ, Haire WD, Feldstein ML. et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993; 341: 507-11.
    CrossrefPubMedGoogle Scholar
  • 19 Goldhaber SZ, Hirsch DR, MacDougall RC. et al. Bolus recombinant urokinase versus heparin in deep venous thrombosis: a randomized controlled trial. Am Heart J 1996; 132: 314-8.
    CrossrefPubMedGoogle Scholar
  • 20 Goldhaber SZ, Vaughan DE, Markis JE. et al. Acute pulmonary embolism treated with tissue plasminogen activator. Lancet 1986; 2: 886-9.
    PubMedGoogle Scholar
  • 21 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-9.
    CrossrefPubMedGoogle Scholar
  • 22 Grossmann C, McPherson S. Safety and efficiacy of catheter –directed thrombolysis for iliofemoral venous thrombosis. Am J Roentgenol 1999; 172: 667-72.
    CrossrefPubMedGoogle Scholar
  • 23 Gruppo Italiano per lo Studio della Streptochinasi nell‘Infarto Miocardico (GISSI).. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 397-402.
    PubMedGoogle Scholar
  • 24 Hacke W, Brott T, Caplan L. et al. Thrombolysis in acute ischemic stroke: controlled trials and clinical experience. Neurology 1999; 53: S3-14.
    CrossrefPubMedGoogle Scholar
  • 25 Hacke W, Kaste M, Fieschi C. et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017-25.
    CrossrefPubMedGoogle Scholar
  • 26 Hacke W, Kaste M, Fieschi C. et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European- Australasian Acute Stroke Study Investigators. Lancet 1998; 352: 1245-51.
    CrossrefPubMedGoogle Scholar
  • 27 Intravenous NPA for the treatment of infarcting myocardium early; InTIME-II, a double-blind comparison of single-bolus lanoteplase vs accelerated alteplase for the treatment of patients with acute myocardial infarction. Eur Heart J 2000; 21: 2005-13.
    CrossrefPubMedGoogle Scholar
  • 28 ISIS-3 (Third International Study of Infarct Survival) Collaborative Group.. ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. Lancet 1992; 339: 753-70.
    CrossrefPubMedGoogle Scholar
  • 29 Kasper W, Konstantinides S, Geibel A. et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997; 30: 1165-71.
    CrossrefPubMedGoogle Scholar
  • 30 Kiil J, Carvalho A, Sakso P. et al. Urokinase or heparin in the management of patients with deep vein thrombosis?. Acta Chir Scand 1981; 147: 529-32.
    PubMedGoogle Scholar
  • 31 Konstantinides S, Geibel A, Heusel G. et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347: 1143-50.
    CrossrefPubMedGoogle Scholar
  • 32 Konstantinidis S, Tiede N, Geibel A. et al. Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol 1998; 82: 966-70.
    CrossrefPubMedGoogle Scholar
  • 33 Menon V, Harrington RA, Hochman JS. et al. Thrombolysis and adjunctive therapy in acute myocardial infarction. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 549S-75S.
    CrossrefPubMedGoogle Scholar
  • 34 Mewissen MW, Seabrook GR, Meissner MH. et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999; 211: 39-49.
    CrossrefPubMedGoogle Scholar
  • 35 Neuhaus KL, Feuerer W, Jeep-Tebbe S. et al. Improved thrombolysis with a modified dose regimen of recombinant tissue-type plasminogen activator. J Am Coll Cardiol 1989; 14: 1566-9.
    CrossrefPubMedGoogle Scholar
  • 36 Ouriel K, Shortell CK, DeWeese JA. et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg 1994; 19: 1021-30.
    CrossrefPubMedGoogle Scholar
  • 37 Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. N Engl J Med 1998; 338: 1105-11.
    CrossrefPubMedGoogle Scholar
  • 38 Ouriel K, Veith FJ, Sasahara AA. Thrombolysis or peripheral arterial surgery: phase I results. J Vasc Surg 1996; 23: 64-75.
    CrossrefPubMedGoogle Scholar
  • 39 PIOPED investigators.. Tissue plasminogen activator for the treatment of acute pulmonary embolism. A collaborative study by the PIOPED investigators. Chest 1990; 97: 528-33.
    CrossrefPubMedGoogle Scholar
  • 40 Razavi MK, Wong H, Kee ST. et al. Initial clinical results of tenecteplase (TNK) in catheter-directed thrombolytic therapy. J endovasc Ther 2002; 9: 593-8.
    CrossrefPubMedGoogle Scholar
  • 41 Ryan TJ, Antman EM, Brooks NH. et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1999; 34: 890-911.
    CrossrefPubMedGoogle Scholar
  • 42 Schwieder G, Grimm W, Siemens HJ. et al. Intermittent regional therapy with rt-PA is not superior to systemic thrombolysis in deep vein thrombosis (DVT)-a German multicenter trial. Thromb Haemost 1995; 7: 1240-3.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 43 Semba CP, Murphy TP, Bakal CW. et al. Thrombolytic therapy with use of alteplase (rt-PA) in peripheral arterial occlusive disease: review of the clinical literature. The Advisory Panel. J Vasc Interv Radiol 2000; 11: 149-61.
    PubMedGoogle Scholar
  • 44 Sinnaeve P, van de Werf F. Fibrinolysis. In: Bhatt DL, Flather MD. (eds). Handbook of acute coronary syndromes. London: Remedica; 2004: 109-33.
    Google Scholar
  • 45 Steiner T, Bluhmki E, Kaste M. et al. The ECASS 3-hour cohort. Secondary analysis of ECASS data by time stratification. ECASS Study Group. European Cooperative Acute Stroke Study. Cerebrovasc Dis 1998; 8: 198-203.
    CrossrefPubMedGoogle Scholar
  • 46 The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators.. A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 1997; 337: 1118-23.
    CrossrefPubMedGoogle Scholar
  • 47 The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581-7.
    CrossrefPubMedGoogle Scholar
  • 48 The STILE Investigators.. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity: the STILE trial. Ann Surg 1994; 220: 251-68.
    CrossrefPubMedGoogle Scholar
  • 49 TransAtlantic Inter-Society Consensus (TASC).. Management of peripheral arterial disease (PAD). Int Angiol 2000; 19 (Suppl. 01) I-XXIV 1-304.
    PubMedGoogle Scholar
  • 50 Urokinase Pulmonary Embolism Trail (UPET).. Phase 1 results: a cooperative study. JAMA 1970; 214: 2163-72.
    CrossrefPubMedGoogle Scholar
  • 51 Van de Werf F, Ardissino D, Betriu A. et al. Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. A Eur Heart J 2003; 24: 28-66.
    PubMedGoogle Scholar
  • 52 Van de Werf F, Barron HV, Armstrong PW. et al. ASSENT-2 Investigators. Assessment of the Safety and Efficacy of a New Thrombolytic. Incidence and predictors of bleeding events after fibrinolytic therapy with fibrin-specific agents: a comparison of TNK-tPA and rt-PA. Eur Heart J 2001; 22: 2253-61.
    CrossrefPubMedGoogle Scholar
  • 53 Van de Werf F, Gore JM, Avezum A. et al. GRACE Investigators. Access to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study. Br Med J 2005; 330 7489 441.
    CrossrefPubMedGoogle Scholar
  • 54 Wardlaw JM, del Zoppo G, Yamaguchi T. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2000; 2: CD000213.
    PubMedGoogle Scholar
  • 55 Wardlaw JM, Sandercock PA, Warlow CP. et al. Trials of thrombolysis in acute ischemic stroke: does the choice of primary outcome measure really matter?. Stroke 2000; 31: 1133-5.
    CrossrefPubMedGoogle Scholar
  • 56 Wells PS, Forster AJ. Thrombolysis in deep vein thrombosis: is there still an indication?. Thromb Haemost 2001; 86: 499-508.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 57 Wilcox RG. General principles of fibrinolytic therapy in acute myocardial infarction. In: Verheugt FWA. (ed). Fibrinolytic therapy in clinical practice. London: Martin Dunitz; 2003: 19-38.
    CrossrefGoogle Scholar
  • 58 Working Party on Thrombolysis in the Management of Limb Ischemia.. Thrombolysis in the management of lower limb peripheral arterial occlusion-- a consensus document. Am J Cardiol 1998; 81: 207-18.
    CrossrefPubMedGoogle Scholar