[Thrombolytics and their use].

Abstract

Thrombolytic agents directly or indirectly activate plasminogen into plasmin, the true thrombolytic being plasmin. Streptokinase is a non-enzyme protein which has occupied the reference position so far. Streptokinase is immunogenic and its activity is neutralised by pre-existing antistreptococcal antibodies. Its administration provokes a systemic activation of fibrinolysis. Urokinase and anisoylated streptokinase-plasminogen complex have no clear advantages when compared with streptokinase. More fibrin specific agents (tissue plasminogen activator, prourokinase) do not improve the risk of bleeding (0.75% in brain). Haemostasis survey does not allow bleeding prediction, but contributes to its control by quantifying the systemic fibrinolytic activity of the drug and checking the anticoagulation level induced by heparin (which is often associated to thrombolysis).