Thrombolysis

Louis R. Caplan; Aishwarya Aggarwal

doi:10.1017/9781009030854.060

Chapter Fifty One - Thrombolysis

from Treatment

Published online by Cambridge University Press: 13 December 2022

Louis R. Caplan and

Aishwarya Aggarwal

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Louis R. Caplan: Affiliation:
Beth Israel Deaconess Medical Centre
Aishwarya Aggarwal: Affiliation:
John F. Kennedy Medical Center

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Summary

Knowledge about thrombosis, the formation of clots, dates back to Virchow, who is discussed in Chapter 13. Perturbation of a vessel leads to release of a thrombokinase that catalyzes the transformation of a precursor protein prothrombin to thrombin. Thrombin, a clot-promoting protein, catalyzes the transformation of fibrinogen (another precursor protein) into fibrin. Fibrin provides the scaffolding that holds clots together. Clots are necessary for survival since they stem bleeding. Equally necessary are chemical reactions that dissolve clots. An “activator” converts plasminogen (another precursor protein) to plasmin, a powerful fibrin-dissolving, clot-dissolving enzyme. Tissue plasminogen activator (tPA) is the molecule in question. It has the special property of acting upon plasminogen only in the presence of fibrin, only where there is a clot. The process of breaking up clots is referred to as thrombolysis. Thrombolytic agents act by breaking up fibrin bridges within thrombi and, in doing so, allow blood to flow. The process is often referred to as fibrinolysis since fibrin is the main target. Fibrinolytic drugs degrade the fibrin network mesh of red erythrocyte-fibrin clots. The formation of thrombi in the body stimulates a natural fibrinolytic mechanism for thrombolysis. Plasmin is formed and its activity is concentrated at the sites of fibrin deposition. The ideal thrombolytic agent would adhere specifically to fibrin in clots and would not affect circulating fibrinogen. Lowering circulating fibrinogen levels excessively could promote bleeding.

Type: Chapter
Information: Stories of Stroke
Key Individuals and the Evolution of Ideas
, pp. 491 - 504

DOI: https://doi.org/10.1017/9781009030854.060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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References

Notes and References

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