Abstract
Thrombolytic therapy involves thrombolytic agents administered to patients suffering
from venous or arterial thrombosis. The therapy induces systemic effects interrelated
with the thrombolytic agent used. Bleeding is a prominent complication of thrombolytic
therapy. Exhaustion of coagulation factors, generation of excessive amounts of fibrin
degradation products (FDPs), therapy-induced activation of coagulation, therapy-induced
anticoagulation, and formation of new fibrin all illustrate the complexity of effects
of the treatment and challenges the hemostatic balance in the patients. The therapy-induced
effects can be modulated by parallel administration of anticoagulants. Risk assessment
is mandatory prior to thrombolytic therapy. Anticoagulated and unconscious patients
represent particular safety concerns, and should be fully evaluated. Several guidelines
describe the choice of tests and their safety limits in relation to pretreatment evaluation
of anticoagulated patients. Fibrinogen depletion and FDPs during treatment may be
promising markers for the evaluation of bleeding risk posttreatment. Future risk assessment
measures should focus on the dynamics of the hemostatic balance. Here, thromboelastography
may be considered a tool addressing clot formation, fibrin structure, and fibrinolytic
resistance in parallel. Suitable laboratory analysis performed shortly after treatment
may help to recognize severe treatment-induced systemic effects that can be counteracted
by rational treatment, thereby reducing bleeding risk.
Keywords
thrombolysis - systemic effects - bleeding risk
