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Haematological disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Further medical or surgical interventions may be necessary in life-threatening pulmonary embolism. Thrombolytic therapy (‘clot busting’ drugs such as streptokinase) may be used, but this is not common in pregnancy except in a life-threatening situation, due to the risk of major haemorrhage and fetal loss79,80. Inferior vena cava filters, which work by intercepting emboli travelling to the pulmonary vasculature, may be used in cases of confirmed recurrent VTE despite anticoagulation62,59. Pulmonary embolectomy, which requires major cardiothoracic surgery, is rarely used and only as a life-saving measure80.
Haematological disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Although anticoagulation treatment (see following section) will be used in most cases, other medical or surgical interventions may be necessary in life-threatening pulmonary embolism. Thrombolytic therapy (‘clot busting’ drugs such as streptokinase) may be used, but this has not previously been common in pregnancy except in a life-threatening situation, due to the risk of major haemorrhage (Ahearn, et al., 2002). In cases where recurring clots are developing, inferior vena cava filters, which work by intercepting emboli travelling to the pulmonary vasculature, have been used safely in pregnancy (Kawamata, et al., 2005). Pulmonary embolectomy is rarely used, but pulmonary angiography, with the use of a guideline wire via a cardiac catheter, may be successful in breaking up the clot (Manganaro, et al., 2000) although there is a high radiation exposure (RCOG, 2007).
Rheological Therapy
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
Streptokinase combines with and activates circulating plasminogen, causing digestion of intravascular fibrin: hence it is used for thrombolytic therapy. Degradation of plasma fibrinogen (to fibrinogen degradation products, FDP) also occurs during streptokinase therapy: the fall in plasma fibrinogen level results in reduction in plasma viscosity, blood viscosity, and red cell aggregation.64-66 These rheological effects may conceivably increase blood flow and contribute to the clinical efficacy of streptokinase therapy in venous thrombosis and arterial disease (Chapter 13, this volume). Clinical application of thrombolytic therapy is increasing rapidly, especially in acute myocardial infarction, and agents which selectively degrade fibrin rather than fibrinogen are under development, e.g., tissue plasminogen activator (t-PA).67 While the thrombolytic efficacy and bleeding risk of such agents may be improved compared to streptokinase, their rheological effects will presumably be less marked, since fibrinogen levels do not fall to the same extent.67
Prevention, treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang province, China: a multicenter, prospective, observational study
Published in Annals of Medicine, 2021
Li Li, Jia Zhou, Liquan Huang, Junhai Zhen, Lina Yao, Lingen Xu, Weimin Zhang, Gensheng Zhang, Qijiang Chen, Bihuan Cheng, Shijin Gong, Guolong Cai, Ronglin Jiang, Jing Yan
The treatment of DVT was conducted according to the 2017 “Guidelines for the Diagnosis and Treatment of Deep Vein Thrombosis (Third Edition)” by the Chinese Society of Vascular Surgery of the Chinese Medical Association and the 2018 Chinese Thoracic Society “Guidelines for the Diagnosis, Treatment, and Prevention of Pulmonary Thromboembolism.” The patients were treated with one drug among UFH, LMWH, and vitamin K antagonists. Moreover, the therapy was changed according to the condition of the patient. The initial dose of UFH was 80–100 U/kg/h intravenously, and then 10–20 U/kg/h intravenously. Afterward, it was adjusted according to the activated partial thromboplastin activity every 4–6 h to extend it to 1.5–2.5 times the normal control value. LMWH was administered according to the bodyweight at a dose of 100 U/kg once every 12 h, subcutaneously. The initial dose of vitamin K antagonists, such as warfarin, was 3.0–5.0 mg/d, starting with 2.5–3.0 mg for patients >75 years old and at high haemorrhage risk. Thrombolysis therapy included streptokinase, urokinase, and recombinant human tissue plasminogen activator (rt-PA), each used alone. The loading dose of streptokinase was 250,000 U intravenously for 30 min, followed by a maintenance intravenous infusion of 100,000 U/h for 12–24 h. The loading dose of urokinase was 4400 U/kg intravenously for 10 min, followed by 2200 U/kg/h continuous intravenous drip for 12 h. The dose of rt-PA was 50 mg, infused continuously for 2 h.
Formulation, optimisation and in-vitro, in-vivo evaluation of surfactant stabilised nanosuspension of Ginkgo biloba
Published in Journal of Microencapsulation, 2019
Saba Aslam, Nazish Jahan, Khalil-Ur-Rehman , Shaukat Ali
Thrombolytic potential of coarse and nanosuspension of G. biloba was determined by in-vitro clot-lysis method. Venous blood was drawn from healthy human volunteers (n = 9) in pre-weighed, sterile centrifuge tubes and incubated at 37 °C for 45 min. Serum was removed after the formation of clot and tubes were weighed again to determine the clot weight. Coarse and nanosuspension (100 µl) of G. biloba were added to tubes containing the blood clot. As a positive and negative control, 100 µl of streptokinase and water were also added in separate tubes having blood clot. All the tubes were kept for 90 min at 37 °C and observed for clot lysis. Tubes were weighed again after the removal of fluid. Positive (streptokinase) and negative (water) control were also run similarly (Khan et al.2011).
Pharmacological thrombolysis: the last choice for salvaging free flaps
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Sik Namgoong, Jong-Phil Yang, Seong Ho Jeong, Seung Kyu Han, Woo Kyung Kim, Eun Sang Dhong
Streptokinase, originating from β-hemolytic streptococci, can form a plasminogen complex and activate other plasminogen substances. Moreover, it works by depleting endogenous plasmin inhibitors, decreasing blood viscosity, and preventing erythrocyte aggregation [22]. Unfortunately, allergic reactions to streptokinase are quite common owing to its bacterial origin and have been reported in 0.1% of patients [21,23,24]. Symptoms include fever, bronchospasm, hypotension, and urticaria. Moreover, inactivation by circulating antibodies can reduce the efficacy of streptokinase [25].rTPA, a second-generation thrombolytic agent, was first identified and isolated from melanoma cells in 1980 [26]. It can bind to fibrin and ultimately stimulate plasminogen. Because it only acts in clots, it theoretically produces fewer systemic bleeding complications [4,25]. However, its high specificity for fibrin has only been observed in vitro [27]. A prospective randomized study has shown no difference in efficacy or safety between urokinase and rTPA [28].