Mühl Diána, Füredi Réka, Gecse Krisztián, Ghosh Subhamay, Falusi Boglárka, Bogár Lajos, Roth Elisabeth, Lantos János
Department of Anaesthesiology and Intensive Therapy, University of Pécs, Pécs, Hungary.
Blood Coagul Fibrinolysis. 2007 Oct;18(7):661-7. doi: 10.1097/MBC.0b013e3282e38e61.
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.
我们研究了大面积或次大面积肺栓塞溶栓过程中血小板聚集和纤维蛋白原水平的变化。15例患者被随机分为超大量链激酶组（UH-SK，n = 8）或阿替普酶组（tPA，n = 7）。在溶栓前及溶栓后4至36小时内每4小时采集动脉血样本，在2至30天内每天采集一次。体外检测血小板聚集情况，包括自发性聚集（0.9%氯化钠溶液）以及用10微摩尔/升肾上腺素、2微克/毫升胶原蛋白和10微摩尔/升二磷酸腺苷诱导的聚集。第一天每8小时测量一次D-二聚体和纤维蛋白原，之后测量时间同上。在UH-SK组，与基线相比，肾上腺素诱导的血小板聚集在4小时和8小时时降低（P < 0.03）。在36小时和第3天时，UH-SK组肾上腺素诱导的血小板聚集显著低于tPA组（P < 0.03）。在UH-SK组，二磷酸腺苷诱导的血小板聚集在4小时时低于基线（P < 0.05）。在UH-SK组，胶原蛋白诱导的血小板聚集在4小时和8小时时低于基线（P < 0.05）。与基线相比，两组溶栓后纤维蛋白原水平均降低。两组在8小时时D-二聚体水平均升高（tPA组P < 0.0004；UH-SK组P < 0.05）。未记录到自发性血小板聚集、严重出血或再栓塞情况。用UH-SK溶栓12小时后血小板聚集降低，相比之下，tPA导致的降低不显著。用UH-SK治疗5天纤维蛋白原水平降低，但用tPA治疗时未检测到显著变化。根据我们的研究结果，tPA是更合适的药物，但链激酶因其成本效益比也有效。
