Ischemic stroke is a common and serious condition. Timely restoration of cerebral perfusion is crucial for improving patient outcomes and reducing economic impacts. For three decades, alteplase has been the only established pharmacological treatment, often combined with endovascular therapy. Tenecteplase, a newer generation of fibrinolytic therapy, is recommended by the ESO 2023 guidelines as a suitable alternative to alteplase, particularly if treatment is initiated within 4.5 hours of symptom onset. Tenecteplase offers higher fibrin specificity, lower binding to PAI-1, and a longer plasma half-life compared to alteplase, allowing for single bolus administration. Clinical studies have shown that tenecteplase 0.25 mg/kg achieves better recanalization and clinical improvement without increased risk of bleeding. It is equally effective and safe as alteplase, with meta-analyses indicating improved recanalization and clinical outcomes at a lower risk of bleeding. Tenecteplase is a suitable alternative for treating iNCMP, especially within 4.5 hours of symptom onset. Its single bolus administration simplifies hospital management and improves the logistics of transporting patients to specialized centers.
- MeSH
- fibrinolýza účinky léků MeSH
- ischemická cévní mozková příhoda * diagnóza farmakoterapie MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- reperfuze klasifikace metody MeSH
- tenektepláza * aplikace a dávkování farmakologie terapeutické užití MeSH
- tkáňový aktivátor plazminogenu farmakologie terapeutické užití MeSH
- trombolytická terapie klasifikace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- akutní koronární syndrom * diagnóza komplikace prevence a kontrola terapie MeSH
- antihypertenziva aplikace a dávkování terapeutické užití MeSH
- antikoagulancia aplikace a dávkování terapeutické užití MeSH
- biologické markery krev MeSH
- elektrokardiografie MeSH
- fibrinolýza MeSH
- infarkt myokardu diagnóza komplikace terapie MeSH
- inhibitory agregace trombocytů aplikace a dávkování terapeutické užití MeSH
- koronární angioplastika metody MeSH
- lidé MeSH
- revaskularizace myokardu metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
BACKGROUND: The risk of acute ischemic stroke (AIS) associated with high estrogen states, including pregnant patients and those using oral contraceptives, has been well documented. We described the histological composition of thrombi collected in these cases. METHODS: From a prospective tissue registry (STRIP registry) of thrombi retrieved during mechanical thrombectomy for AIS, we identified 5 patients with high estrogen states: 1 post-partum patient, 1 undergoing hormone replacement therapy and 3 consuming oral contraceptive pills. Five male control patients were randomly chosen matched by age. Immunohistochemistry for CD42b (platelets), von Willebrand factor (vWF), thrombin-activatable fibrinolysis inhibitor (TAFI), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) was performed. Expression was quantified using Orbit Image Software. Student's t-test was performed as appropriate. RESULTS: Mean TAFI content for the high estrogen state group was higher than controls (25.6 ± 11.9% versus 9.3 ± 9.0%, p = 0.043*). Mean platelet content for the high estrogen state group was lower than controls (41.7 ± 10.6% versus 61.8 ± 12.9%, p = 0.029*). No significant difference was found in vWF, fibrinogen and PAI-1 expression. Mean time to recanalize was higher in the high estrogen state group compared to the control group (57.8 ± 27.6 versus 22.6 ± 11.4 min, p = 0.0351*). The mean number of passes required was higher in the high estrogen group compared to controls 4.6 versus 1.2, p = 0.0261*). CONCLUSIONS: TAFI expression, a powerful driver of thrombosis, was significantly higher in stroke thrombi among patients with high estrogen states compared to controls.
- MeSH
- cévní mozková příhoda * MeSH
- estrogeny MeSH
- fibrinogen metabolismus MeSH
- fibrinolýza MeSH
- inhibitor aktivátoru plazminogenu 1 MeSH
- ischemická cévní mozková příhoda * MeSH
- karboxypeptidasa B2 * MeSH
- lidé MeSH
- trombóza * MeSH
- von Willebrandův faktor MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Článek formou přehledu shrnuje soudobý pohled na základní principy patofyziologie, diagnostiky a léčby traumatem indukované koagulopatie u pacientů se závažným úrazem.
This narrative review article summarizes the contemporary view on the basic principles of pathophysiology, diagnosis and treatment of trauma-induced coagulopathy in patients with severe trauma.
Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that can lead to irreversible loss of vision. Intravenous thrombolysis (IVT) has been used experimentally for its treatment. Our study aimed to evaluate the effect of emergency IVT on CRAO and its impact on visual acuity outcomes. We conducted a retrospective observational study of patients with CRAO. A total of 46 patients with CRAO were analysed; 16 patients received IVT treatment (IVT group) while 30 did not (no-IVT group). Seven patients from the IVT group received IVT early, within 4.5 hours (h) after the onset of symptoms (early-IVT), and 9 patients received it beyond this timeframe (late-IVT). The median time-to-hospital was 8.5 h: 3 h for the IVT group and 24 h for the no-IVT group. The median time-to-treatment was 5 h. The median outcome of visual acuity was 0.05 in the early-IVT, 0.025 in the late-IVT, and 0.01 in the no-IVT group. Among patients who received IVT early, 86% exhibited significant visual improvement. This improvement was four-fold greater compared to all other groups (p = 0.040), including the late-IVT (p = 0.011) and no-IVT groups (p = 0.023). No complications of the treatment were reported. Our study confirms that the administration of IVT treatment for CRAO within the 4.5-h time window is both safe and effective.
Kardiochirurgický výkon v mimotělním oběhu je spojen s aktivací celého systému hemostázy včetně systému fibrinolytického. Antifibrinolytika jsou jednou z nejvíce studovaných lékových skupin v kardiochirurgii za poslední dvě dekády. Existují přesvědčivé důkazy o jejich příznivém vlivu na redukci krvácení a spotřebu transfuzí, přesto panují obavy o jejich bezpečnosti. Tato práce stručně popisuje mechanismy fibrinolýzy, účinek aprotininu a lysinových analog a jejich současnou pozici v kardiochirurgii.
Cardiac surgery using cardiopulmonary bypass is associated with common activation of whole hemostatic system including fibrinolysis. Antifibrinolytics are the most extensively studied drugs in modern cardiac surgery during the last two decades. There is a strong evidence about their impact on reduction of bleeding and transfusion requirement but some questions about their safety still remain. This article illustrates briefly mechanism of fibrinolysis, effect of aprotinin and lysine analogues and their current place in cardiac surgery.
- MeSH
- antifibrinolytika * farmakologie terapeutické užití MeSH
- fibrinolýza účinky léků MeSH
- kardiochirurgické výkony MeSH
- lidé MeSH
- mimotělní oběh MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
A male patient with a history of immobilization due to motor weakness, was transferred to our emergency department after syncope during physiotherapy, with recorded hypotension. Transthoracic echocardiography showed severe dilatation of the right ventricle (RV), with apex hypercontractility and almost akinetic RV free wall. The above findings, in addition to the unexpected visualization of a large, free-floating, right atrial thrombus, a rare finding associated with high mortality, readily confirmed the clinical suspicion of acute pulmonary embolism (PE) causing circulatory collapse. Intravenous fibrinolysis and vasopressor therapy were successfully administered, and hemodynamic instability was soon alleviated.
- MeSH
- echokardiografie MeSH
- fibrinolýza MeSH
- lidé MeSH
- nemoci srdce * MeSH
- plicní embolie * diagnostické zobrazování farmakoterapie MeSH
- trombóza * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Coagulopathy and bleeding is a frequent phenomenon in patients on extracorporeal membrane oxygenation. The cause may be multifactorial and it may change over time. We present a case when bleeding was caused by hyperfibrinolysis induced by oxygenator. The diagnosis was established by comparing thromboelastometry result from blood obtained before and after oxygenator. Hyperfibrinolysis and bleeding could be successfully treated merely by oxygenator exchange.
- MeSH
- dospělí MeSH
- fibrinolýza fyziologie MeSH
- lidé MeSH
- mimotělní membránová oxygenace metody MeSH
- oxygenátory normy MeSH
- tromboelastografie metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Primární perkutánní koronární intervence (PCI) je v současné době široce preferovanou reperfuzní strategií pro terapii infarktu myokardu, a to vzhledem k superiorním výsledkům ve srovnání s trombolytickou terapií. Nicméně přítomnost masivního intrakoronárního trombu u pacientů s infarktem myokardu je často spojena s nepříznivými procedurálními výsledky, včetně selhání aspirace a neúspěšné reperfuze. Podání nízké dávky intrakoronární trombolýzy u pacientů s infarktem myokardu s ST elevacemi a masivním trombem po insuficientní PCI a trombektomii má za následek zmenšení trombotické nálože, zlepšení epikardiálního flow a zlepšení perfuze (1, 2).
Primary percutaneous coronary intervention (PCI) is currently a widely preferred reperfusion strategy for myocardial infarction therapydue to superior results compared to thrombolytic therapy. However, the presence of massive intracoronary thrombus in patients withmyocardial infarction is often associated with adverse procedural results, including failure of aspiration and failure of reperfusion. Administrationof a low dose of intracoronary thrombolysis in patients with myocardial infarction with ST elevations and massive thrombusafter insufficient PCI and thrombectomy resulted in decreased thrombotic burden, improvement of epicardial flow and perfusion.
- MeSH
- fibrinolýza účinky léků MeSH
- infarkt myokardu s elevacemi ST úseků * diagnóza chirurgie terapie MeSH
- koronární angioplastika * metody trendy MeSH
- koronární cévy chirurgie účinky léků MeSH
- koronární trombóza diagnóza komplikace terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- statistika jako téma MeSH
- stenty škodlivé účinky trendy MeSH
- trombektomie metody trendy MeSH
- trombocytový glykoproteinový komplex IIb-IIIa antagonisté a inhibitory terapeutické užití účinky léků MeSH
- trombolytická terapie * metody trendy MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Serine proteases are important virulence factors for many pathogens. Recently, we discovered a group of trypsin-like serine proteases with domain organization unique to flatworm parasites and containing a thrombospondin type 1 repeat (TSR-1). These proteases are recognized as antigens during host infection and may prove useful as anthelminthic vaccines, however their molecular characteristics are under-studied. Here, we characterize the structural and proteolytic attributes of serine protease 2 (SmSP2) from Schistosoma mansoni, one of the major species responsible for the tropical infectious disease, schistosomiasis. METHODOLOGY/PRINCIPAL FINDINGS: SmSP2 comprises three domains: a histidine stretch, TSR-1 and a serine protease domain. The cleavage specificity of recombinant SmSP2 was determined using positional scanning and multiplex combinatorial libraries and the determinants of specificity were identified with 3D homology models, demonstrating a trypsin-like endopeptidase mode of action. SmSP2 displayed restricted proteolysis on protein substrates. It activated tissue plasminogen activator and plasminogen as key components of the fibrinolytic system, and released the vasoregulatory peptide, kinin, from kininogen. SmSP2 was detected in the surface tegument, esophageal glands and reproductive organs of the adult parasite by immunofluorescence microscopy, and in the excretory/secretory products by immunoblotting. CONCLUSIONS/SIGNIFICANCE: The data suggest that SmSP2 is secreted, functions at the host-parasite interface and contributes to the survival of the parasite by manipulating host vasodilatation and fibrinolysis. SmSP2 may be, therefore, a potential target for anti-schistosomal therapy.
- MeSH
- fibrinolýza účinky léků MeSH
- hemokoagulace účinky léků MeSH
- hemostatika antagonisté a inhibitory MeSH
- krevní tlak účinky léků MeSH
- molekulární modely MeSH
- plazminogen účinky léků MeSH
- proteinové domény MeSH
- proteiny červů chemie genetika farmakologie MeSH
- proteolýza účinky léků MeSH
- rekombinantní proteiny MeSH
- Schistosoma mansoni enzymologie MeSH
- schistosomiasis mansoni parazitologie MeSH
- sekvence aminokyselin MeSH
- serinové endopeptidasy chemie genetika farmakologie MeSH
- tkáňový aktivátor plazminogenu účinky léků MeSH
- vazodilatace účinky léků MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
