[Actual state of thrombolytic treatment of recent vein thrombosis and pulmonary embolism (author's transl)].
Recent deep vein thrombosis of the iliofemoral segment often leads to pulmonary embolism and to impaired valve function. Although more common, occlusions in the calf veins are less dangerous, and often a self-limiting disorder as almost half of these thrombi lyse spontaneously. Approximately 70% of fresh deep venous thrombi dissolve under intensive and prolonged thrombolytic treatment with streptokinase and long-term follow-up studies indicate that normal valve function is preserved in those patients in whom thrombus clearance was obtained. Thrombosis with streptokinase or urokinase appears to be the current treatment of choice for most cases of massive and severe, life-threatening pulmonary embolism; those patients surviving more than an hour or so after massive infarction comprise a prognostically better group, in whom the chances of surviving embolectomy is today smaller than the probability of survival without surgery but with thrombolytic treatment. Obviously there are problems in the evaluation but also in the thrombolytic treatment with streptokinase and urokinase of deep venous thrombosis and pulmonary embolism. These problems do not concern the principle of thrombolysis, but are largely due to the fact that the drugs so far used also induce a systemic fibrinogenolysis resulting in a bleeding risk. There is already good evidence that tissue activator of plasminogen is highly specific for fibrin and can induce thrombolysis in experimental animals without inducing systemic fibrinogenolysis.
D000818:Animals; D005263:Femoral Artery; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007083:Iliac Artery; D010960:Plasminogen Activators / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy*; D013300:Streptokinase / Q000627:therapeutic use; D013924:Thrombophlebitis / Q000188:drug therapy*; D013927:Thrombosis / Q000188:drug therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator
Etat actuel du traitement thrombolytique des thromboses veineuses récentes et de l'embolie pulmonaire.