Role of Thrombolytic Therapy in ICU Patients
Nasef saied Abdel Fattah Meshaheet;
Abstract
Thrombosis is an important part of the normal hemostatic response that limits hemorrhage caused by microscopic or macroscopic vascular injury. Physiologic thrombosis is counterbalanced by intrinsic antithrombotic properties and fibrinolysis. under normal conditions, a thrombus is confined to the immediate area of injury and does not obstruct flow to critical areas, unless the blood vessel lumen is already diminished, as it is in atherosclerosis.
Under pathological conditions, a thrombus can propagate into otherwise normal vessels. A thrombus that has propagated where it is not needed can obstruct flow in critical vessels; it can also obliterate valves and other structures that are essential to normal hemodynamic function.
The coagulation cascade of hemostasis has two pathways which lead to fibrin formation. These are the contact activation pathway (also known as the intrinsic pathway), and the tissue factor pathway (also known as the extrinsic pathway). It was previously thought that the coagulation cascade consisted of two pathways of equal importance joined to a common pathway, also the cell-based model better explains the mechanism of haemostasis in vivo and includes the important interactions between cells directly involved in haemostasis. and coagulation factors.
Fibrinolytic system is a highly regulated mechanism that, on deposition of fibrin within the vascular system, converts the proenzyme plasminogen into the active enzyme plasmin, which in turn degrades fibrin.
To achieve normal haemostasis, Thrombin generation is regulated by a number of inhibitors. Direct plasma inhibitors of thrombin include antithrombin and heparin cofactor II. Indirect inhibitors include tissue factor pathway inhibitor, the thrombomodulin, protein C, protein S, and fetal anticoagulant
The thrombolytic agents available today are serine proteases that work by converting plasminogen to the natural fibrinolytic agent plasmin. Plasmin lyses clot by breaking down the fibrinogen and fibrin contained in a clot.
The thrombolytic drugs include: Reteplase, Streptokinase Urokinase and other types .These drugs are most effective if administered immediately after it has been determined they are clinically appropriate. The advantage of administration is highest within the first sixty minutes after a thrombotic event, but may extend up to six hours after the start of symptoms.
Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a cleaved product called plasmin. Plasmin is a proteolytic enzyme that is capable of breaking cross-links between fibrin molecules, which provide the structural integrity of blood clots. Because of these actions, thrombolytic drugs are also called "plasminogen activators" and "fibrinolytic drugs."
Indication of thrombolytic therapy: Acute myocardial infarction (AMI), Deep vein thrombosis (DVT), Pulmonary embolism (PE), Acute ischemic stroke (AIS), Acute peripheral arterial occlusion and Occlusion of indwelling catheters.
Under pathological conditions, a thrombus can propagate into otherwise normal vessels. A thrombus that has propagated where it is not needed can obstruct flow in critical vessels; it can also obliterate valves and other structures that are essential to normal hemodynamic function.
The coagulation cascade of hemostasis has two pathways which lead to fibrin formation. These are the contact activation pathway (also known as the intrinsic pathway), and the tissue factor pathway (also known as the extrinsic pathway). It was previously thought that the coagulation cascade consisted of two pathways of equal importance joined to a common pathway, also the cell-based model better explains the mechanism of haemostasis in vivo and includes the important interactions between cells directly involved in haemostasis. and coagulation factors.
Fibrinolytic system is a highly regulated mechanism that, on deposition of fibrin within the vascular system, converts the proenzyme plasminogen into the active enzyme plasmin, which in turn degrades fibrin.
To achieve normal haemostasis, Thrombin generation is regulated by a number of inhibitors. Direct plasma inhibitors of thrombin include antithrombin and heparin cofactor II. Indirect inhibitors include tissue factor pathway inhibitor, the thrombomodulin, protein C, protein S, and fetal anticoagulant
The thrombolytic agents available today are serine proteases that work by converting plasminogen to the natural fibrinolytic agent plasmin. Plasmin lyses clot by breaking down the fibrinogen and fibrin contained in a clot.
The thrombolytic drugs include: Reteplase, Streptokinase Urokinase and other types .These drugs are most effective if administered immediately after it has been determined they are clinically appropriate. The advantage of administration is highest within the first sixty minutes after a thrombotic event, but may extend up to six hours after the start of symptoms.
Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a cleaved product called plasmin. Plasmin is a proteolytic enzyme that is capable of breaking cross-links between fibrin molecules, which provide the structural integrity of blood clots. Because of these actions, thrombolytic drugs are also called "plasminogen activators" and "fibrinolytic drugs."
Indication of thrombolytic therapy: Acute myocardial infarction (AMI), Deep vein thrombosis (DVT), Pulmonary embolism (PE), Acute ischemic stroke (AIS), Acute peripheral arterial occlusion and Occlusion of indwelling catheters.
Other data
| Title | Role of Thrombolytic Therapy in ICU Patients | Other Titles | دور عقاقيرمذيبات الجلطة فى الحالات المختلفة فى العناية المركزة | Authors | Nasef saied Abdel Fattah Meshaheet | Issue Date | 2015 |
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