scholarly journals The Effect of Intrathecal Fibrinolytic Therapy with Tissue Type Plasminogen Activator (t-PA) on Cerebral Vasospasm after Subarachnoid Hemorrhage

1991 ◽  
Vol 19 (2) ◽  
pp. 318-322
Author(s):  
Masanori MORIMOTO ◽  
Takamaru TANABE ◽  
Makoto ARIMITSU ◽  
Hikaru MIZOBUCHI ◽  
Koreaki MORI
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Plasminogen Activator ◽  
Cerebral Vasospasm ◽  
Fibrinolytic Therapy ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator

Fibrin Metabolism in Patients with Acute Myocardial Infarction During and After Treatment with Tissue-Type Plasminogen Activator

1988 ◽  
Vol 60 (03) ◽  
pp. 428-433 ◽  
Author(s):  
Michael E Ring ◽  
Samuel M Butman ◽  
Denise C Bruck ◽  
William M Feinberg ◽  
James J Corrigan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Molecular Markers ◽  
Plasminogen Activator ◽  
Degradation Products ◽  
Fibrinolytic Therapy ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Fibrin Degradation Products ◽  
Type Plasminogen Activator

SummaryIn order to define some of the determinants of successful thrombolysis and reocclusion during fibrinolytic therapy for acute myocardial infarction (AMI), specific molecular markers of fibrin metabolism were serially measured in 15 patients with AMI treated with tissue-type plasminogen activator (t-PA). Fibrin formation was assessed by measurement of fibrinopeptide A (FpA) and fibrinolysis by assay of B-P peptides 1—42 and 15—42 and crosslinked fibrin degradation products (XDP). At baseline, FpA levels were high while markers of fibrinolysis were near normal. Following a 90-minute infusion of t-PA (0.5—1.1 mg kg−1 hr−1), all markers of fibrinolysis increased. Levels of FpA remained elevated despite heparin at the initiation of cardiac catheterization. None of these markers discriminated between patients with successful reperfusion from those without. At 4 hours, B-β 15—42 peptide and XDP levels remained elevated suggesting persistence of fibrinolysis beyond the short circulatory half-life of t-PA. FpA levels at 4 hours were lower in patients who underwent acute coronary angioplasty compared to those who received additional low dose t-PA (12.3 ± 4.5 vs. 30.4 ± 5.5 ng/ ml, p <0.05). By 48 hours, markers of fibrinolysis had returned toward normal except in 2 patients with persistently elevated B-P 15—42 peptide levels who suffered reocclusion on days 5 and 6 (75 and 44 vs. 29 ± 3 nM, p <0.005). In conclusion, molecular markers of fibrin metabolism during fibrinolytic therapy may provide clinically relevant data.

Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator

1993 ◽  
Vol 78 (3) ◽  
pp. 430-437 ◽  
Author(s):  
Kazuo Mizoi ◽  
Takashi Yoshimoto ◽  
Akira Takahashi ◽  
Satoru Fujiwara ◽  
Keiji Koshu ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Cerebral Vasospasm ◽  
Therapy Group ◽  
Intrathecal Injection ◽  
Neurological Deficits ◽  
Tissue Type ◽  
Control Group ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Cisternal Drainage

✓ The authors have evaluated the efficacy of postoperative intrathecal injections of tissue-type plasminogen activator (tPA) in preventing cerebral vasospasm in patients with a diffuse thick subarachnoid hemorrhage (SAH). The present study examined 105 patients who underwent direct surgery within 48 hours of SAH and whose computerized tomography (CT) findings were classified as Fisher CT Group 3. Patients showing diffuse thick subarachnoid blood clots on CT with greater than 75 Hounsfield units (HU) were included in the tPA therapy group and those with below 75 HU comprised the control group. The surgical method was the same in both groups, and both groups had cisternal drainage instituted. On the day following the operation, the tPA group was given an intrathecal injection of tPA (2 mg), and this was continued for several days until all of the cisterns exhibited low density on CT scans. Follow-up angiography showed that 26 cases (87%) in the tPA group had no vasospasm, three (10%) had moderate vasospasm, and one (3%) had severe vasospasm. All four patients showing spasm on angiography were asymptomatic, and there were no cases of delayed ischemic neurological deficits (DIND). In contrast, there were 11 cases (15%) with DIND in the control group. In the tPA group, there was one case of SAH caused by drainage catheter removal, one with a small epidural hematoma, and one with subgaleal fluid accumulation; all of these were treated conservatively with favorable results. Overall, there were no infectious complications related to cisternal drainage and intrathecal injection of tPA. These results indicate that multiple intrathecal injections of small doses of tPA are effective and safe in preventing vasospasm. On the basis of this experience, the authors conclude that injection of 2 mg of tPA daily for 5 days (a total of 10 mg) is effective in preventing the development of vasospasm.

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