Thrombolysis, clot selectivity, and kinetics.
Thrombolysis, clot selectivity, and kinetics.
复制标题
溶栓、凝块选择性和动力学。
作者：
B. Sobel;R. Gross;A. Robison
当《流通》的编辑部搬到圣路易斯时，一系列的“观点”就开始了。第一篇发表于1983年8月，涉及冠状动脉血栓溶解。这预示着在接下来的12个月内，《循环》杂志将发表11篇关于溶栓的文章。- 目前正在审查另外13个国家。考虑的一个焦点是纤维蛋白溶解激活剂如组织型纤溶酶原激活剂（t-PA）的“凝块选择性”的潜在重要性。凝块选择性的优点。凝块选择性似乎使得t-PA可用于冠状动脉血栓溶解，部分原因是：（1）凝块溶解可以用不诱导以消耗α 1-抗纤溶酶、纤溶酶原消耗、纤维蛋白原溶解、增加循环纤维蛋白原降解产物（FDP）和全身出血倾向为特征的全身溶解状态的剂量的t-PA来完成;3. 14（2）与传统激活剂相比，t-PA的生物半衰期较短，因此在成功溶栓后可以立即开始对高度残余冠状动脉狭窄进行确定性手术治疗（约5分钟）和其缺乏全身溶解状态的诱导;（3）与链激酶和其他非凝块选择性激活剂相比，t-PA诱导溶解后动脉切开部位出血的频率可能较低，（4）早期治疗疑似梗死，提供最大的心肌挽救机会，使用选择性凝块激活剂可能比使用链激酶或尿激酶更合理，因为可以避免与全身溶解状态相关的风险;和（5）与链霉菌毒素相比，t-PA全身大剂量给药可能更实用。
WHEN the editorial offices of Circulation moved to St. Louis, a series of "Perspectives" was initiated. The first, published in August 1983, dealt with coronary thrombolysis. It presaged the publication in Circulation of 11 manuscripts concerning thrombolysis within the next 12 months. -, An additional 13 are presently in review. One focus of consideration has been the potential importance of "clot selectivity" of activators of fibrinolysis such as tissue-type plasminogen activator (t-PA). Advantages of clot selectivity. Clot selectivity appears to render t-PA useful for coronary thrombolysis in part because: (1) Clot lysis can be accomplished with t-PA in doses that do not induce a systemic lytic state characterized by consumption of c,-antiplasmin, depletion of plasminogen, fibrinogenolysis, increased circulating fibrinogen degradation products (FDPs), and predisposition to systemic bleeding;3. 14 (2) Definitive surgical treatment of high-grade residual coronary stenosis can be initiated promptly after successful thrombolysis with t-PA in contrast to conventional activators because of its short biological half-life (approximately 5 min) and its lack of induction of a systemic lytic state; (3) Bleeding from arteriotomy sites may be less frequent after lysis induced with t-PA compared with streptokinase and other non-clot selective activators, perhaps because of the conspicuous, anticoagulant effects of elevated FDPs and prolonged depletion of fibrinogen; (4) Early treatment of suspected infarction offering the greatest opportunity for myocardial salvage may be more justifiable with a clot-selective activator than with streptokinase or urokinase because risks associated with a systemic lytic state can be avoided; and (5) Systemic administration of large doses may be more practical with t-PA compared with strepto-
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使用组织型纤溶酶原激活剂对进展型心肌梗死患者进行冠状动脉溶栓。
DOI：
10.1056/nejm198403083101001
发表时间：
1984
期刊：
The New England journal of medicine
影响因子：
--
作者：
VandeWerf,F;Ludbrook,PA;Bergmann,SR;Tiefenbrunn,AJ;Fox,KA;deGeest,H;Verstraete,M;Collen,D;Sobel,BE
通讯作者：
Sobel,BE
静脉内和冠状动脉内链激酶治疗急性心肌梗死的前瞻性随机试验。
影响因子：
37.8
作者：
Rogers,WJ;Mantle,JA;HoodJr,WP;Baxley,WA;Whitlow,PL;Reeves,RC;Soto,B
通讯作者：
Soto,B
影响因子：
56.9
作者：
Bergmann;K. Fox;M. Ter-pogossian;B. Sobel;D. Collen
通讯作者：
Bergmann;K. Fox;M. Ter-pogossian;B. Sobel;D. Collen
在心肌梗死发展过程中，冠状动脉内给予链激酶可持续改善左心室功能和死亡率。
影响因子：
37.8
作者：
Smalling,RW;Fuentes,F;Matthews,MW;Freund,GC;Hicks,CH;Reduto,LA;Walker,WE;Sterling,RP;Gould,KL
通讯作者：
Gould,KL
组织型纤溶酶原激活剂或链激酶诱导冠状动脉溶栓后局部心肌代谢的改善。
影响因子：
37.8
作者：
Sobel,BE;Geltman,EM;Tiefenbrunn,AJ;Jaffe,AS;SpadaroJr,JJ;Ter-Pogossian,MM;Collen,D;Ludbrook,PA
通讯作者：
Ludbrook,PA