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Pharmacologic and clinical characteristics of thrombolytic agents

Steven R Deitcher1, Michael R Jaff

  • 1Section of Hematology and Coagulation Medicine and Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.

Reviews in Cardiovascular Medicine
|April 29, 2004
PubMed

Insights

Newer plasminogen activators (PAs) for dissolving blood clots show no significant advantage over older agents like urokinase for peripheral vascular thrombosis. Current data suggest similar efficacy and safety profiles, questioning the benefits of newer thrombolytic therapies.

Area of Science:

  • Vascular Medicine
  • Pharmacology
  • Thrombosis Research

Background:

  • Arterial and venous thromboembolic events are life-threatening vascular diseases.
  • Anticoagulant therapy is standard for preventing further clot formation.
  • The fibrinolytic system plays a crucial role in natural clot resolution.

Purpose of the Study:

  • To evaluate the efficacy and safety of newer plasminogen activator (PA) thrombolytic agents.
  • To compare newer PAs with established agents like urokinase for peripheral vascular thrombosis.
  • To assess the risk of bleeding associated with newer PA formulations.

Main Methods:

  • Review of pharmacokinetic and pharmacodynamic properties of various PA thrombolytic agents.
  • Analysis of clinical data comparing newer fibrin-specific PAs with urokinase.
  • Evaluation of safety profiles, including bleeding risks like intracranial hemorrhage.

Main Results:

  • Newer PAs, including fibrin-specific agents, have varying properties.
  • Continuous infusions of newer PAs are used for peripheral vascular thromboses.
  • Data do not compellingly show superior efficacy or safety of newer PAs over urokinase for peripheral thrombosis.

Conclusions:

  • Current evidence does not support significantly greater efficacy or safety of newer PAs compared to urokinase for peripheral vascular thrombosis.
  • The risk of bleeding, including intracranial hemorrhage, may increase with newer tissue-type plasminogen activator-based PAs.
  • Further research may be needed to clarify the role and benefits of newer thrombolytic agents.

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