Pulse-spray pharmaco-mechanical thrombolysis for acute proximal deep vein thrombosis

The aim of this study was to evaluate the efficacy, safety, and feasibility of pulse-spray pharmaco-mechanical thrombolysis for treating patients with proximal deep vein thrombosis [DVT]. We studied 24 consecutive patients [14 men, 10 women, with mean age 36 years, range,19-59 years], with acute [less than 15 days] proximal DVT affecting the iliofemoral vein in 18 patients [75%], and/or femoro-popliteal vein in 6 patients [25%]. They were diagnosed by clinical examination, duplex ultrasonography. Contrast venography at the beginning of thrombolysis was done. All were treated with pulse-spray technique, using streptokinase, through the popliteal vein puncture under guidance of duplex scanning. Early success was assessed by comparing the pre- and post-treatment venographic severity score. All patients were discharged at oral Warfarin and followed by duplex scanning for one year. The average total dose of streptokinase was 3.6 million IU [range; 2.55-9.6 million IU] and the average duration of therapy was 2.4 days [range: 1-4 days]. Complete lysis was achieved in 12 patients [50%], partial lysis in 11 patients [45.8%], and suboptimal lysis in only one patient [4.1%]. Adjusted dose of heparin was used in conjunction with thrombolysis. In one case stenotic iliac vein lesion were uncovered after thrombolysis, and another one in the common femoral vein, both treated by balloon dilatation. There was no major treatment-related complication. The use of selective intra-thrombus pulse-spray pharmaco-mechanical thrombolysis was safe and effective approach for treating acute proximal DVT with minimal complications

Correlation between ST-Segment regression and infarct-related artery patency in acute myocardial infarction

The need for an immediate and accurate assessment of the success of thrombolysis in acute myocardial infarction [AMI] is invaluable. The aim of this study was to assess the usefulness and accuracy of the rate of ST segment regression in detecting reperfusion after thrombolytic therapy in the setting of AMI. Forty patients [35 males and 5 females] with a first AMI were included. Their mean age was 47.4 +/- 8 years. All patients received 1.5 million units of streptokinase. Coronary angiography was performed for all patients within 24 hours from the time of initiation of therapy. The TIMI criteria was used for grading the perfusion of the infarctrelated artery [IRA]. A 12- leads ECG was done on admission, immediately after streptokinase [60 minutes from the start of therapy] and 4 hours after streptokinase. Rapid ST segment regression was defined as >/= 50% regression of the total score of ST segment elevation in leads showing the infarction. According to the result of coronary angiography, the patients were subdivided into 2 groups: Group P [n = 23]: patients with a patent IRA and Group O [n = 1 7]: those with occluded IRA. The mean percent of ST segment regression at 60 minutes after streptokinase was significantly lower in group P [56 +/- 13%] than group O [30.4 +/- 8%] [P < 0.05]. Among the 23 patients in group P, 17 had >/= 50% ST regression at 60 minutes and 6 had < 50% [sensitivity: 74%]. Among the 17 patients in group O, 14 had < 50% ST regression and 3 had >/= 50% [specificity: 82%]. Thus ST segment regression showed good correlation with IRA potency in the setting of AMI and can be used as a reliable indicator of success of reperfusion

Base farmacológica de la terapia trombolítica / Pharmacologic base of thrombolytic therapy

En este trabajo se revisan los mecanismos de los trombolíticos sobre la disolución del coágulo de fibrina al agruparse en activadores del plasminógeno, proteasas y fibrinolíticos indirectos. De los activadores del plasminógeno se consideran detalladamente el metabolismo y la farmacología de los trombolíticos tradicionales estreptoquinasa y uroquinasa, así como plasminógeno y los complejos plasminógeno estreptoquinasa acilada. En el segundo grupo se analiza la bien conocida plasmina y también nuevas proteasas aisladas de hongos. Del tercer grupo, por ser éste el más heterógeneo, se ilustran las más importantes vías de acción de esas sustancias