LABORATORY MONITORING OF SUCCESS AND FAILURE OF THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

In clinical practice it would be desirable to monitor the clinical course and outcome of thrombolytic therapy by use of non-invasive laboratory methods, From the test systems available, the determination of specific myocardial necrosis markers seem to be at the moment of highest clinical value, Markers of thrombin activation might indicate failure of therapy and/or tendency for thrombotic reocclusion with all commercially available fibrin specific or non-specific thrombolytic agents but have failed to be of prognostic value for the individual patient or have not been investigated in sufficient numbers of patients, No clinical usefulness has been found so far for determination of markers of plasmin activation, Accordingly, specific control parameters of thrombolytic therapy with rt-PA have not been shown to be useful as predictive marker for clinical outcome of thrombolytic therapy in the individual patient with acute myocardial infarction, However, determination of t-PA and PAI-1 plasma levels is of interest with respect to investigation of pathophysiological contexts and their influence on efficacy of thrombolysis and should, therefore, be taken into account in clinical trials using t-PA or related substances for thrombolytic therapy.