Fibrinogen Breakdown, Long-Lasting Systemic Fibrinolysis, and Procoagulant Activation During Alteplase Double-Bolus Regimen in Acute Myocardial Infarction

Stangl, Karl; Laule, Michael; Tenckhoff, Bernhard; Stangl, Verena; Gliech, V.; Dübel, Peter; Grohmann, Andrea; Melzer, Christoph; Langel, J; Wernecke, Klaus D.; Baumann, Gert; Ziemer, Sabine

doi:10.1016/s0002-9149(98)00018-6

Cited by 25 publications

(17 citation statements)

References 24 publications

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“…These results are consistent with observations of procoagulant tendencies (eg, increase in fibrinopeptide A) induced by thrombolysis for myocardial infarction. [13][14][15] Interestingly, control subjects with vascular risk factors exhibited a significant activation of hemostasis compared with control subjects without such risk factors. Compared with risk factor-matched subjects, patients with acute ischemic stroke exhibited a significant increase in hemostatic indicators.…”

Section: Discussionmentioning

confidence: 99%

Changes in Coagulation and Fibrinolysis Markers in Acute Ischemic Stroke Treated With Recombinant Tissue Plasminogen Activator

Faßbender

Dempfle

Mielke

et al. 1999

Stroke

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Background and Purpose-Shifts of the balance between coagulation and fibrinolysis play a crucial role in pathogenesis and treatment of cerebral ischemia. In this study, we characterized the kinetics of hemostatic abnormalities induced by acute ischemic stroke and its thrombolytic (recombinant tissue plasminogen activator [rtPA]) or anticoagulant (heparin) treatment. Methods-Systemic generation of molecular markers of hemostasis (fibrin monomer, D-dimer, thrombin-antithrombin complex, and fibrinopeptide 1.2) was monitored in acute ischemic stroke, and the effects of thrombolytic and anticoagulant treatments were analyzed. Results-Thrombolysis with rtPA induced a massive response of markers of coagulation activation and fibrin formation that peaked after 1 to 3 hours and persisted for up to 72 hours. In contrast, only minor hemostatic changes were induced by acute ischemic stroke itself. Administration of heparin did not significantly affect these hemostatic abnormalities. Conclusions-This first characterization of the coagulation activation induced by rtPA treatment for acute ischemic stroke and the failure to abolish such hemostatic abnormalities by heparin may be of value for further refinement of the currently discussed thrombolytic therapy and the controversial adjunctive anticoagulant prophylaxis in stroke patients.

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Section: Discussionmentioning

confidence: 99%

Changes in Coagulation and Fibrinolysis Markers in Acute Ischemic Stroke Treated With Recombinant Tissue Plasminogen Activator

Faßbender

Dempfle

Mielke

et al. 1999

Stroke

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“…On the other hand, other studies on post-fibrinolysis hemostatic changes in myocardial infarction patients have shown that fibrinogen reaches its lowest point some time between 90 minutes and 3 hours. 21,22 On these grounds, and on the pharmacologic basis of the short rtPA halflife, we decided to restrict the analysis of fibrinogen levels to 2 hours post-thrombolysis, assuming a very early fibrinogen-related coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen Decrease after Intravenous Thrombolysis in Ischemic Stroke Patients Is a Risk Factor for Intracerebral Hemorrhage

Vandelli

Marietta

Gambini

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Similar findings were reported for thrombolysis in myocardial infarction. 9 However, the clinical significance of these findings is unknown. Finally, secondary intracerebral hemorrhage is a major concern after thrombolytic therapy in ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Low-Dose Intravenous Thrombolysis in a Stroke Patient With Distal Basilar Thrombus

Veltkamp

Jacobi

Kress

et al. 2006

Stroke

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Background and Purpose-Patients with high-grade basilar artery stenosis secondary to thromboembolism are at high risk of developing subsequent vessel occlusion. Optimal medical management of this condition is unclear. Summary of Case-We present a patient with a small subacute brain stem infarction and filiform distal basilar residual lumen attributable to arterioarterial or cardiogenic embolism. Beginning 3 days after symptom onset, low-dose intravenous thrombolysis with 0.125 mg/kg recombinant tissue plasminogen activator was continuously infused for 48 hours. Follow-up magnetic resonance angiography revealed complete resolution of the embolus. No further cerebral ischemic episodes occurred during 3-month follow-up, and the basilar artery remained patent. Conclusion-Our observation suggests a potential for prolonged low-dose intravenous thrombolysis in basilar artery embolism, but further data are needed to judge the effectiveness and risk of this intervention. (Stroke. 2006;37:e9-e11.)

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Fibrinogen Breakdown, Long-Lasting Systemic Fibrinolysis, and Procoagulant Activation During Alteplase Double-Bolus Regimen in Acute Myocardial Infarction

Cited by 25 publications

References 24 publications

Changes in Coagulation and Fibrinolysis Markers in Acute Ischemic Stroke Treated With Recombinant Tissue Plasminogen Activator

Changes in Coagulation and Fibrinolysis Markers in Acute Ischemic Stroke Treated With Recombinant Tissue Plasminogen Activator

Fibrinogen Decrease after Intravenous Thrombolysis in Ischemic Stroke Patients Is a Risk Factor for Intracerebral Hemorrhage

Prolonged Low-Dose Intravenous Thrombolysis in a Stroke Patient With Distal Basilar Thrombus

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