Baker William F
Center for Health Sciences, UCLA, USA.
Clin Appl Thromb Hemost. 2002 Oct;8(4):291-314. doi: 10.1177/107602960200800401.
The therapeutic use of thrombolytic agents is the natural result of the increasing understanding of the pathophysiologic mechanisms underlying normal and deranged thrombosis and fibrinolysis. Plasminogen activators capable of increasing the production of plasmin exhibit considerable efficacy in the treatment of a variety of arterial and venous thrombotic disorders. The ideal thrombolytic agent has yet to be developed but the desired clinical result of rapid opening of the thrombosed vessel without reocclusion, without activation of systemic fibrinogenolysis, and without a risk of hemorrhage is well defined. Clinical studies clearly demonstrate that the addition of a variety of adjunctive agents to the available thrombolytics enhances benefit without inordinate risk. The addition of intravascular angioplasty and stenting to thrombolysis increases the potential long-term benefit. Newer thrombolytic agents and new protocols for the use of existing therapies offer the promise of saving many who would otherwise succumb to coronary or cerebral arterial thrombosis or to venous thromboembolism.
溶栓剂的治疗应用是对正常和异常血栓形成及纤维蛋白溶解的病理生理机制的认识不断增加的自然结果。能够增加纤溶酶生成的纤溶酶原激活剂在治疗各种动脉和静脉血栓性疾病方面显示出相当大的疗效。理想的溶栓剂尚未开发出来，但快速开通血栓血管而无再闭塞、不激活全身性纤维蛋白溶解且无出血风险的理想临床结果已明确界定。临床研究清楚地表明，在现有溶栓剂中添加各种辅助药物可在不过度增加风险的情况下提高疗效。在溶栓治疗中增加血管内血管成形术和支架置入术可增加潜在的长期益处。更新的溶栓剂和现有疗法的新使用方案有望挽救许多原本会死于冠状动脉或脑动脉血栓形成或静脉血栓栓塞的患者。
