THROMBOLYSIS IN THROMBOEMBOLIC DISEASES

Thrombolysis in many manifestations of thromboembolic disease offers a valuable alternative to surgery. However, as thrombolysis is always a ssociated with a bleeding hazard (though low) one should always weigh the risks against the expected benefits when the decision for or again st this therapeutic option is made. Furthermore, in selecting the appr opriate thrombolytic agent, one should be led by the urgency of reperf usion to maintain organ function. If one decides on an aggressive, hig h-dose, brief-duration regimen, reperfusion may be achieved more rapid ly but may be incomplete in the majority of cases. On the other hand, by selecting an intermediate- or long-duration, low-dose regimen, repe rfusion may happen too late to improve the patient's prognosis. Above all, one should keep in mind that the hazard of serious bleeding const antly increases with duration of thrombolysis. No matter which strateg y is regarded as the best to resolve a clot in a particular patient wi th a particular type of thromboembolic disease, thrombolysis should be accompanied by high doses of i.v. heparin. Finally, if bleeding occur s in spite of all precautions taken, the new generation of fibrin-spec ific thrombolytic agents offers the advantage of short half-lives. In addition - in contrast to streptokinase - the hemostatic defect that t hey cause may be rapidly reversed by the infusion of antagonistic drug s such as aprotinin, tranexamic acid, or epsilon-aminocaproic acid. Th is adds to the clinical safety profile of these thrombolytic agents.