Experience in the use of non-immunogenic recombinant staphylokinase in the treatment of massive pulmonary embolism

N. Semigolovskii, I. S. Simutis, D. S. Salygina, M. S. Danilov, A. Svetlikov, S. N. Semigolovskii
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Abstract

The actuality of the problem of pulmonary embolism is due to the widespread occurrence of this complication with unpredictable consequences, including hemodynamic instability, arterial hypotension, shock, disability and sudden death. Pulmonary embolism is now considered in developed countries as the most common cause of preventable inhospital death and maternal mortality. Thrombolytic therapy is used for intermediate and high-risk pulmonary embolism with hemodynamic instability of the patient, however, there is also ongoing discussion about the possibilities of its implementation in normotensive patients under certain conditions. Currently, streptokinase, urokinase and alteplase (Actilize and Revelise in Russia) are used for thrombolytic therapy of pulmonary embolism. Indications for use in pulmonary embolism have been expanded recently for the already wellknown domestic thrombolytic non-immunogenic staphylokinase (Fortelizin®), which has proven itself in patients with acute myocardial infarction and acute ischemic stroke. A clinical case of delayed (on the 4th day of hospitalization) use of Fortelisin with a positive effect in a 49-year-old normotensive anemized patient with syncope in the PE debut with non-occlusive thrombosis of the posterior tibial veins without flotation of blood clots is presented. The features of Fortelizin, which favorably distinguish it from other thrombolytic agents, are: the highest fibrin selectivity; the possibility of bolus administration of a fixed dosage, independent of the patient’s body weight; safety of repeated administration; high rate of onset of effect; prevention of a significant decrease in blood fibrinogen levels, which reduces the risk of bleeding. Thus, the use of the domestic thrombolytic recombinant non-immunogenic staphylokinase drug Fortelizin, taking into account the data of the conducted studies and the described case, seems to be a successful example of import substitution in medicine.
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使用非免疫原性重组葡萄球菌激酶治疗大面积肺栓塞的经验
肺栓塞问题的实际情况是,这种并发症广泛发生,其后果难以预料,包括血流动力学不稳定、动脉低血压、休克、残疾和猝死。在发达国家,肺栓塞现已被视为可预防的住院死亡和孕产妇死亡的最常见原因。溶栓疗法主要用于患者血流动力学不稳定的中高危肺栓塞,然而,关于在某些条件下对血压正常的患者实施溶栓疗法的可能性也一直存在讨论。目前,链激酶、尿激酶和阿替普酶(俄罗斯为 Actilize 和 Revelise)被用于肺栓塞的溶栓治疗。最近,已在急性心肌梗塞和急性缺血性中风患者中得到证实的国内知名溶栓药物非免疫原性葡萄激酶(Fortelizin®)的肺栓塞适应症也有所扩大。本文介绍了一例延迟(住院第 4 天)使用 Fortelisin 并取得积极疗效的临床病例,患者 49 岁,血压正常,无风湿病史,在 PE 初诊时出现晕厥,胫后静脉非闭塞性血栓形成,无血块漂浮。福替利嗪有别于其他溶栓药物的特点是:纤维蛋白选择性最高;可栓塞给药,剂量固定,与患者体重无关;重复给药安全;起效率高;可防止血纤维蛋白原水平显著下降,从而降低出血风险。因此,考虑到已开展研究的数据和所述病例,使用国产溶栓重组非免疫原性葡萄激酶药物 Fortelizin 似乎是进口替代药物的一个成功范例。
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