FIBRINOLYSIS WAS REPLACED BEFORE IT WAS UNDERSTOOD.

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology Pub Date : 2024-11-04 DOI:10.1159/000542197
Victor Gurewich, David Segarnick
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Abstract

Introduction Fibrinolysis is often wrongly believed to be due to tissue plasminogen activator (tPA) alone. Instead, both endogenous plasminogen activators are required, but only a mini bolus of tPA is needed to initiate fibrinolysis. This is due to tPA's unique high fibrin affinity binding site located on the fibrin D-domain. Both activators are present in all normal plasma, consistent with both being involved in biological fibrinolysis, which is also the model for optimal therapeutic fibrinolysis. Methods This uses a sequential combination of a 5 mg mini bolus of tPA followed by an infusion of proUK (40 mg/hr) for 90 minutes. This treatment is both highly effective and free of side effects. Results By contrast, due to a misunderstanding of fibrinolysis, tPA is often administered alone. This requires doses of 90-100 mg of tPA over 60 minutes, which is neither very effective nor safe, due to a risk of bleeding complications from the lysis of hemostatic fibrin by tPA's fibrin affinity. Due to this problem, fibrinolysis was replaced by interventional procedures, like percutaneous coronary intervention (PCI), which is much slower, limited to clots larger than the catheter, but is generously reimbursed by third party payers.

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纤溶在被理解之前就被取代了。
导言 人们常常错误地认为纤溶仅是组织纤溶酶原激活剂(tPA)的作用。相反,两种内源性纤溶酶原激活剂都需要,但只需要少量的 tPA 就能启动纤溶。这是由于 tPA 位于纤维蛋白 D-结构域上的独特高纤维蛋白亲和力结合位点。这两种激活剂都存在于所有正常血浆中,因此两者都参与了生物纤溶,这也是最佳治疗性纤溶的模型。方法 这是一种连续的组合疗法,先注射 5 毫克小剂量 tPA,然后输注 proUK(40 毫克/小时),持续 90 分钟。这种治疗方法既高效又无副作用。结果 相比之下,由于对纤维蛋白溶解的误解,tPA 通常被单独使用。这需要在 60 分钟内注射 90-100 毫克的 tPA,既不十分有效,也不安全,因为 tPA 的纤维蛋白亲和力会溶解止血纤维蛋白,从而有可能引起出血并发症。由于这个问题,纤维蛋白溶解术被经皮冠状动脉介入治疗(PCI)等介入治疗程序所取代,后者的治疗速度要慢得多,仅限于比导管大的血块,但第三方支付机构会给予慷慨的报销。
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来源期刊
Cardiology
Cardiology 医学-心血管系统
CiteScore
3.40
自引率
5.30%
发文量
56
审稿时长
1.5 months
期刊介绍: ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.
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