[Value of laboratory diagnosis in thrombolytic therapy]

Today, profound insight into the clotting and fibrinolytic systems during therapeutic thrombolysis is offered by a variety of laboratory assays. While the purpose of scientific investigations is to increase the knowledge on changes imposed by the mechanism of thrombolysis, the rationale for performing coagulation assays during thrombolytic therapy is to increase the safety of treatment. To make laboratory monitoring of thrombolytic therapy most effective, the main issues which should be solved should be defined. The main reasons for performing coagulation assays during and after thrombolytic therapy are: 1. To monitor the adjunctive anticoagulant therapy. 2. To detect potential bleeding hazards early, and 3. in case bleeding complications occur, to help to optimise of the therapeutic strategies to avoid excessive diagnostics. Most of the methods affording an insight into coagulation and fibrinolysis are not very helpful in terms of improved therapeutic safety. Too frequent repetition of assays is likewise superfluous. In our opinion, clinical routine monitoring should consist of red blood cell count, aPTT, and fibrinogen according to Clauss' method which should be repeated during the first 48 hours after initiation of therapy at 8- to 12-hour intervals. It must be mentioned in this respect that fibrinogen according to Clauss' method during thrombolytic therapy must be regarded an assay to estimate the global coagulation potential of the blood rather than to quantify fibrinogen levels. In our opinion, it is this that makes the Clauss' method superior to other methods of fibrinogen determination.