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Fibrinolíticos: indicações e tratamento das complicações hemorrágicas / Fibrinolytics: indications and treatment of hemorrhagic complications
Baruzzi, Antonio Cláudio do; Stefanini, Edson; Manzo, Gianni.
  • Baruzzi, Antonio Cláudio do; Hospital TotalCor. São Paulo - SP. BR
  • Stefanini, Edson; Universidade Federal de São Paulo. São Paulo - SP. BR
  • Manzo, Gianni; Hospital TotalCor. São Paulo - SP. BR
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 421-427, out.-dez. 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-970567
RESUMO
Os fibrinolíticos pertencem a uma classe de medicamentos especializada em promover a lise da fibrina e a consequente dissolução do trombo. Esse efeito baseia-se na transformação do plasminogênio em plasmina, potente enzima proteolítica. A sua aplicação nas diferentes síndromes cardiovasculares agudas alterou o curso natural do infarto agudo do miocárdio, da embolia pulmonar e do acidente vascular cerebral isquêmico agudo. Na prática, temos três gerações de fibrinolíticos disponíveis estreptoquinase, alteplase e tenecteplase, essa última com alta afinidade à fibrina. As complicações hemorrágicas, embora raras, devem ser identificadas e tratadas de forma precoce. Isso se deve aos distúrbios da coagulação, especialmente, queda do fibrinogênio e outros fatores de coagulação, mais predominantes com a estreptoquinase. A correção baseia-se na administração de crioprecipitado e plasma fresco, ricos, respectivamente, em fibrinogênio e fatores de coagulação. A inexperiência ao administrar tais medicamentos e o receio hemorrágico tem sido fator agravante na sobrevida dessas doenças. Campanhas educacionais poderão amenizar tal cenário, especialmente, em centros mais carentes de recursos tecnológicos
ABSTRACT
Fibrinolytics belong to a class of drugs specialized in promoting lysis of fibrin and consequent dissolution of the thrombus. This effect is based on the conversion of plasminogen into plasmin, a potent proteolytic enzyme. Its application in different acute cardiovascular syndromes has changed the natural course of acute myocardial infarction, pulmonary embolism, and acute ischemic stroke. In practice, three generations of fibrinolytics are available streptokinase, alteplase, and tenecteplase (the latter having high affinity to fibrin). Hemorrhagic complications, although rare, must be identified and treated early. This is due to coagulation disorders, especially the decrease in fibrinogen and other coagulation factors, more prevalent with streptokinase. Correction is based on the administration of cryoprecipitate and fresh plasma, which are rich in fibrinogen and coagulation factors, respectively. Inexperience in administering these drugs and hemorrhagic fear are aggravating factors of disease progression. Educational programs can mitigate such scenarios, especially in centers that lack technological resources.Inexperience administering such medicines and hemorrhagic fear has been an aggravating factor in the lives of these diseases. Educational campaigns will be able to mitigate such a scenario especially in the most lacking centers of technological resources
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Thrombolytic Therapy / Fibrinolytic Agents / Hemorrhage / Myocardial Infarction Type of study: Prognostic study Limits: Adult / Female / Humans / Male Language: English / Portuguese Journal: Rev. Soc. Cardiol. Estado de Säo Paulo Journal subject: Cardiology Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital TotalCor/BR / Universidade Federal de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Thrombolytic Therapy / Fibrinolytic Agents / Hemorrhage / Myocardial Infarction Type of study: Prognostic study Limits: Adult / Female / Humans / Male Language: English / Portuguese Journal: Rev. Soc. Cardiol. Estado de Säo Paulo Journal subject: Cardiology Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital TotalCor/BR / Universidade Federal de São Paulo/BR