[Thrombosis in unstable angina. Is there a role for thrombolytic agents?].
Intracoronary thrombosis is more and more considered as a major etiological factor of unstable angina (UA). The physiopathological diagram from ulceration of the plaque to unstable then stable thrombosis is based on many arguments: pathological (Falk-Fuster), biological, angioscopic (Forrester) and finally angiographic; numerous studies have demonstrated the frequency of non-obstructive coronary thrombi in UA. Their frequency is directly related to the delay in control, in relation with the last painful episode, indicating the spontaneous lysis of the clot. This role suggests the beneficial effect of a thrombolytic treatment. Several non-randomized studies (Vetrovek, Mandelkorn, Gotoh, Vermeer) demonstrate reduction of the clots after thrombolysis. But considering spontaneous lysis, only randomized studies published to date (Gold, Topol and Nicklas) report encouraging results. More extended studies are necessary to specify the beneficial effect and the exact haemorrhagic risk of this treatment and the probable place of additional tests like transluminal coronary angioplasty (TCA) and aortocoronary by-pass.
Raynaud
P
P
Clinique Cardiologique, Hôpital Trousseau, Tours.
Desveaux
B
B
Pacouret
G
G
D000787:Angina Pectoris / Q000209:etiology*; D000789:Angina, Unstable / Q000209:etiology*; D003327:Coronary Disease; D003328:Coronary Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans
D005343:Fibrinolytic Agents
La thrombose dans l'angor instable. Une place pour les thrombolytiques?