Grünewald M, Seifried E
Abteilung Innere Medizin III, Universität Ulm.
Z Kardiol. 1993;82 Suppl 2:129-35.
Numerous attempts to predict the hazard of bleeding during therapeutic fibrinolysis by means of the analysis of parameters for coagulation or fibrinolytic systems have failed to produce reliable results. In the near future the measurement of markers of enhanced thrombin activity TAT, FPA and, to a lesser extent, F1+2 may provide an important non-invasive diagnostic tool with satisfactory reliability for the prediction of thromboembolic events or rethrombosis after successful recanalization by thrombolytic therapy. Measurement of fibrin(ogen) degradation products, such as D-dimers, FbDP and FgDP may provide important help for the diagnosis of thromboembolic events or the danger of reocclusion, though they still lack specificity and are therefore unsuitable as the solely base for diagnosis or therapeutic decisions. Efficient control of anticoagulation with heparin is practicable through the measurement of aPTT. For the prevention of artifacts correct collection and processing of blood samples is mandatory; sample tubes must contain inhibitors of fibrinolytic action such as PPACK or aprotinin.
通过分析凝血或纤维蛋白溶解系统参数来预测治疗性纤维蛋白溶解期间出血风险的众多尝试均未产生可靠结果。在不久的将来，增强凝血酶活性标志物TAT、FPA以及程度稍轻的F1+2的测量，可能会提供一种重要的非侵入性诊断工具，其在预测溶栓治疗成功再通后的血栓栓塞事件或再血栓形成方面具有令人满意的可靠性。纤维蛋白（原）降解产物（如D-二聚体、FbDP和FgDP）的测量可能为血栓栓塞事件的诊断或再闭塞风险提供重要帮助，尽管它们仍缺乏特异性，因此不适合作为诊断或治疗决策的唯一依据。通过测量活化部分凝血活酶时间（aPTT）可实现对肝素抗凝的有效控制。为防止出现假象，必须正确采集和处理血样；样本管必须含有纤维蛋白溶解作用抑制剂，如PPACK或抑肽酶。
