title: Time course of platelet aggregation during thrombolytic treatment of massive pulmonary embolism.
abstract: We studied changes in platelet aggregation and fibrinogen levels during thrombolysis with massive or submassive pulmonary embolism. Fifteen patients were randomized into ultrahigh-dose streptokinase (UH-SK n = 8) or alteplase (tPA n = 7) groups. Arterial blood samples were taken before and after thrombolysis every 4 h between 4 and 36 h, and once daily between 2 and 30 days. In-vitro platelet aggregation was examined as spontaneous (0.9% NaCl) and induced aggregation with adrenaline 10 micromol/l, collagen 2 microg/ml and ADP 10 micromol/l. D-dimer and fibrinogen were measured every 8 h on first day, and later as above. In the UH-SK group, adrenaline-induced platelet aggregation decreased at 4 and 8 h compared with baseline (P < 0.03). Adrenaline-induced platelet aggregation was significantly lower in the UH-SK group than in the tPA group at 36 h and on day 3 (P < 0.03). Platelet aggregation induced by ADP was lower at 4 h than at baseline in the UH-SK group (P < 0.05). Collagen-induced platelet aggregation was lower at 4 and 8 h than at baseline (P < 0.05) in the UH-SK group. Compared with baseline, fibrinogen levels decreased in both groups after thrombolysis. D-dimer levels were elevated in both groups at 8 h (tPA group, P < 0.0004; UH-SK group, P < 0.05). Spontaneous platelet aggregation, major bleeding or re-embolism was not documented. Platelet aggregation decreased after thrombolysis with UH-SK for 12 h, in comparison tPA caused an insignificant decrease. Fibrinogen level decreased with UH-SK treatment for 5 days but in case of tPA we could not measure significant changes. According to our findings, tPA is a more suitable drug but streptokinase is also effective because of its cost-benefit ratio.
authors: Department of Anaesthesiology and Intensive Therapy, University of Pécs, Pécs, Hungary. diana.muhl@aok.pte.hu
authors: Diána
authors: D
authors: Mühl
authors: Réka
authors: R
authors: Füredi
authors: Krisztián
authors: K
authors: Gecse
authors: Subhamay
authors: S
authors: Ghosh
authors: Boglárka
authors: B
authors: Falusi
authors: Lajos
authors: L
authors: Bogár
authors: Elisabeth
authors: E
authors: Roth
authors: János
authors: J
authors: Lantos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects*; D011655:Pulmonary Embolism / Q000097:blood* / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D013300:Streptokinase / Q000494:pharmacology / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D005340:Fibrinogen; D013300:Streptokinase; D010959:Tissue Plasminogen Activator