LABORATORY MONITORING OF SUCCESS AND FAILURE OF THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

In clinical practice it would be desirable to monitor the clinical cou rse and outcome of thrombolytic therapy by use of non-invasive laborat ory methods, From the test systems available, the determination of spe cific myocardial necrosis markers seem to be at the moment of highest clinical value, Markers of thrombin activation might indicate failure of therapy and/or tendency for thrombotic reocclusion with all commerc ially available fibrin specific or non-specific thrombolytic agents bu t have failed to be of prognostic value for the individual patient or have not been investigated in sufficient numbers of patients, No clini cal usefulness has been found so far for determination of markers of p lasmin activation, Accordingly, specific control parameters of thrombo lytic therapy with rt-PA have not been shown to be useful as predictiv e marker for clinical outcome of thrombolytic therapy in the individua l patient with acute myocardial infarction, However, determination of t-PA and PAI-1 plasma levels is of interest with respect to investigat ion of pathophysiological contexts and their influence on efficacy of thrombolysis and should, therefore, be taken into account in clinical trials using t-PA or related substances for thrombolytic therapy.