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Basic Aspects of Fibrinolysis and Thrombolysis

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Coronary Circulation and Myocardial Ischemia

Part of the book series: Update in Intensive Care Medicine ((UICMSOFT,volume 32))

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Abstract

The hypothesis underlying thrombolytic therapy of thromboembolic disease is that early and sustained recanalization prevents cell death, reduces infarct size, preserves organ function, and reduces early and late mortality. Thrombolysis consists of the pharmacological dissolution of the blood clot, by intravenous infusion of plasminogen activators that activate the fibrinolytic system (Fig. 1). The fibrinolytic system includes a proenzyme, plasminogen, which is converted by plasminogen activators to the active enzyme plasmin, which in turn digests fibrin to soluble degradation products. Inhibition of the fibrinolytic system occurs by plasminogen activator inhibitors (mainly plasminogen activator inhibitor-1, PAI-1) and by plasmin inhibitors (mainly α2-antiplasmin) [1]. Thrombolytic agents that are either approved or under clinical investigation in patients with acute myocardial infarction include streptokinase, recombinant tissue-type plasminogen activator (rt-PA or alteplase), rt-PA derivatives such as reteplase and TNK-rtPA, anisoylated plasminogen-streptokinase activator complex (APSAC or anistreplase), two-chain urokinase-type plasminogen activator (tcu-PA or urokinase), recombinant single-chain u-PA (scu-PA, pro-u-PA or prourokinase), and recombinant staphylokinase and derivatives [2].

Schematic representation of the fibrinolytic system. The proenzyme plasminogen is activated to the active enzyme plasmin by tissue-type or urokinase-type plasminogen activator. Plasmin degrades fibrin into soluble fibrin degradation products. Inhibition of the fibrinolytic system may occur at the level of the plasminogen activators, by plasminogen activator inhibitors, or at the level of plasmin, mainly by α2-antiplasmin

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Authors and Affiliations

  1. Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium

    H. R. Lijnen

  2. Center for Molecular and Vascular Biology, University of Leuven, Campus Gasthuisberg O&N, Leuven, Belgium

    D. Collen

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  1. H. R. Lijnen
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  2. D. Collen
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Editor information

Editors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Michael R. Pinsky MD, CM, FCCP, FCCM (Director of Research Division of Critical Care Medicine Professor of Anesthesiology and Critical Care Medicine) (Director of Research Division of Critical Care Medicine Professor of Anesthesiology and Critical Care Medicine)

  2. Department of Cell Biology and Physiology, Autonomous University, Barcelona, Spain

    Antonio Artigas MD, PhD (Director of Critical Care Center Sabadell Hospital Associate Professor) (Director of Critical Care Center Sabadell Hospital Associate Professor)

  3. Paris, France

    Jean-Francois Dhainaut MD, PhD (Director of Medical Intensive Care Unit Dean of Cochin Port-Royal Medical School Vice-President of Paris University) (Director of Medical Intensive Care Unit Dean of Cochin Port-Royal Medical School Vice-President of Paris University)

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© 2002 Springer-Verlag Berlin Heidelberg

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Lijnen, H.R., Collen, D. (2002). Basic Aspects of Fibrinolysis and Thrombolysis. In: Pinsky, M.R., Artigas, A., Dhainaut, JF. (eds) Coronary Circulation and Myocardial Ischemia. Update in Intensive Care Medicine, vol 32. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57212-8_6

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  • DOI: https://doi.org/10.1007/978-3-642-57212-8_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42588-5

  • Online ISBN: 978-3-642-57212-8

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