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Das Fibrinolysesystem und seine Aktivatoren

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Thrombolyse und Antikoagulation in der Kardiologie

Zusammenfassung

Das Fibrinolysesystem des Menschen ist ein proteolytischer enzymatischer Prozeß im Blut mit der Aufgabe, intravaskuläre thrombotische Vorgänge örtlich zu begrenzen und thrombotisch verschlossene Gefäße wieder zu eröffnen. Das Hauptenzym des Fibrinolysesystems ist die aktive Protease Plasmin, die durch Aktivierung der inaktiven Vorstufe Plasminogen durch sog. Plasminogenaktivatoren über eine limitierte Proteolyse entsteht. Die thrombolytische Therapie mit Plasminogenaktivatoren imitiert und verstärkt die physiologische Fibrinolyse. Für den klinischen Einsatz stehen derzeit die nicht–physiologischen Thrombolytika Streptokinase und APSAC (azylierter Plasminogen–Streptokinase–Aktivator–Komplex) und die physiologischen Plasminogenaktivatoren Urokinase und Gewebeplasminogenaktivator (t–PA) zur Verfügung. Während die 3 ersteren eine systemische Aktivierung des Fibrinolysesystems bewirken, besitzt t–PA eine relative Fibrinselektivität. Noch nicht für die Therapie thromboembolischer Erkrankungen zugelassen, jedoch in klinischer Erprobung, sind die fibrinselektiv wirkende Prourokinase sowie eine rekombinante Mutante von t–PA mit einer verlängerten In–vivo–Halbwertszeit. In der Entwicklung befinden sich Mutanten, Hybridenzyme und Konjugate, die zum Ziel haben, durch Veränderung der Halbwertszeit, der Thrombusaffinität und der thrombolytischen Aktivität zu einer weiteren Optimierung dieses therapeutischen Konzepts zu führen. Die Entwicklung hochwirksamer Antithrombotika wird das Ergebnis der thrombolytischen Therapie weiter verbessern helfen.

Erstmals veröffentlicht in: Innere Medizin 48 (1993) 272–282. Georg Thieme Verlag, Stuttgart New York

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Authors
  1. E. Seifried
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Editors and Affiliations

  1. Abt. für Innere Medizin, William-Harvey-Klinik, Kaiserberg 6, Bad Nauheim, 61231, Deutschland

    Viola Hach-Wunderle

  2. Abt. Innere Medizin II, Städtische Kliniken Kassel, Mönchebergstraße 41–43, Kassel, 34125, Deutschland

    K.-L. Neuhaus

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© 1994 Springer-Verlag Berlin Heidelberg

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Seifried, E. (1994). Das Fibrinolysesystem und seine Aktivatoren. In: Hach-Wunderle, V., Neuhaus, KL. (eds) Thrombolyse und Antikoagulation in der Kardiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-46810-0_1

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  • DOI: https://doi.org/10.1007/978-3-642-46810-0_1

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  • Print ISBN: 978-3-540-58295-3

  • Online ISBN: 978-3-642-46810-0

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