[Laboratory monitoring of thrombolytic therapy in clinical practice and research]

Numerous attempts to predict the hazard of bleeding during therapeutic fibrinolysis by means of the analysis of parameters for coagulation or fibrinolytic systems have failed to produce reliable results. In the near future the measurement of markers of enhanced thrombin activity TAT, FPA and, to a lesser extent, F1+2 may provide an important non-invasive diagnostic tool with satisfactory reliability for the prediction of thromboembolic events or rethrombosis after successful recanalization by thrombolytic therapy. Measurement of fibrin(ogen) degradation products, such as D-dimers, FbDP and FgDP may provide important help for the diagnosis of thromboembolic events or the danger of reocclusion, though they still lack specificity and are therefore unsuitable as the solely base for diagnosis or therapeutic decisions. Efficient control of anticoagulation with heparin is practicable through the measurement of aPTT. For the prevention of artifacts correct collection and processing of blood samples is mandatory; sample tubes must contain inhibitors of fibrinolytic action such as PPACK or aprotinin.