Fibrinolytic Therapy in Clinical Practice

Book Cover......Page 1
Half-Title......Page 2
Title......Page 3
Copyright......Page 4
Contents......Page 6
Contributors......Page 7
Preface......Page 10
t-PA and variants......Page 11
Streptokinase and derivatives......Page 15
t-PA and variants......Page 16
Streptokinase and derivatives......Page 17
t-PA and variants......Page 18
Streptokinase and derivatives......Page 21
Staphylokinase and derivatives......Page 22
Conclusions......Page 23
References......Page 24
Introduction......Page 29
Restoring vessel patency......Page 30
Adding aspirin......Page 32
Improving treatment schedules......Page 33
Reteplase (r-PA)......Page 34
Tenecteplase (TNK-rt-PA)......Page 36
Vessel patency and microvascular perfusion......Page 37
Stroke......Page 38
Failed thrombolysis and ‘rescue’......Page 39
After thrombolysis, then what?......Page 40
Clinical guidelines and treatment schedules......Page 41
Concluding comments......Page 42
References......Page 44
Pathogenesis......Page 48
Aspirin......Page 51
GP llb/llla antagonists......Page 53
Monotherapy vs anticoagulation therapy......Page 62
Monotherapy vs combination therapy......Page 63
Clopidogrel......Page 64
References......Page 65
Antithrombin therapy in fibrinolysis......Page 70
Oral anticoagulation after myocardial infarction (Table 4.3)......Page 73
Conclusions......Page 77
References......Page 78
Introduction......Page 80
Beta blockers......Page 81
Angiotensin-converting enzyme (ACE) inhibitors......Page 83
Calcium channel blockers......Page 84
Recommendations......Page 85
Verapamil......Page 86
Magnesium......Page 87
Nitrates......Page 88
Lipid lowering drugs......Page 89
Adenosine......Page 90
Improvement of microvascular function......Page 91
Neutrophils......Page 92
References......Page 93
Angioplasty vs fibrinolytic therapy......Page 100
Percutaneous transluminal coronary angioplasty (PTCA)......Page 102
Cardiogenic shock......Page 104
Stenting vs balloon angioplasty......Page 106
References......Page 110
Time is muscle—and muscle is life......Page 113
Treatment delay in clinical practice, and the need for pre-hospital triage and therapy......Page 115
Randomized trials of pre-hospital vs in-hospital fibrinolysis......Page 118
Benefits and risks in pre-hospital fibrinolysis......Page 122
Pre-hospital fibrinolysis: the Dutch experience......Page 125
Fibrinolysis or primary angioplasty?......Page 128
References......Page 129
Background: epidemiology, natural history and prognosis......Page 133
Fibrinolytic therapy......Page 134
Catheter-directed fibrinolytic therapy......Page 135
Background: epidemiology, natural history and prognosis......Page 138
Efficacy of fibrinolytic therapy: surrogate markers......Page 139
Efficacy of fibrinolytic therapy: clinical outcomes......Page 140
Massive pulmonary embolism......Page 142
Dose regimen......Page 146
Summary: practical guidelines......Page 147
References......Page 148
Initial patient assessment......Page 152
The rt-PA trials......Page 153
ECASS I......Page 154
ATLANTIS......Page 155
Meta-analyses......Page 156
Phase IV trials of intravenous thrombolysis and cost aspects......Page 157
Intra-arterial thrombolysis for acute ischaemic stroke......Page 163
PROACT II......Page 164
Diagnostic imaging and thrombolytic therapy......Page 165
Conclusion, recommendations and future prospects......Page 167
References......Page 168
Index......Page 174