Fibrinolytic Therapy in Clinical Practice by Freek Verheugt

By Freek Verheugt

This booklet is a pragmatic instruction within the medical program of fibrinolytic treatment in various life-threatening problems. it's not an encyclopedia for all trials in commonly evidence-based cures. it's intended for physicians taking good care of acute in poor health sufferers both at extensive care devices, coronary care devices or emergency departments.

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The main action of acetylsalicylic acid is the inhibition of cyclooxygenase: it irreversibly inactivates the enzyme, acetylates serine529 at the apex of the COX-1 long hydrophobic channel (the main cyclooxygenase site) and thereby excludes arachidonic acid from the channel. Aspirin is generally considered to be a weak platelet antagonist, but its therapeutic results are better than those of far more potent antiplatelet agents with potentially greater clinical effectiveness. 9 Since then, aspirin has become the gold standard of care for patients with myocardial infarction.

14 Ridogrel Ridogrel is a thromboxane A2 synthase inhibitor and a prostaglandin endoperoxide receptor agonist. 15, 16 GP llb/llla antagonists Rationale for their use in AMI GP llb/llla receptor inhibitors block the final pathway of any agonist-induced platelet aggregation by inhibiting the binding of fibrinogen to the receptor of activated platelets in a dose-dependent manner. They also have a disaggregating effect on the white thrombus, which becomes a truly thrombolytic effect on platelet aggregates.

Am Heart J 2001; 141:742–50. Simoons ML, Maggioni AP, Knatterud G et al. Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet 1993; 342: 1523–8. Squire IB, Lawley W, Fletcher S et al. 5 years after administration of streptokinase for acute myocardial infarction. Eur Heart J 1999; 20:1245–52. Jennings K. Antibodies to strep-tokinase. BMJ1996; 312:393–4. Schröder R, Dissman R, Brüggermann T, Wegscheider K, Linderer T, Tebbe U. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction.

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