Histoire de la thrombolyse
Séance du mercredi 01 juin 2022 (Traitement moderne de l’embolie pulmonaire grave)
N° de DOI : 10.26299/na05-kx39/emem.2022.19.01
Résumé
La reconnaissance de la production par le streptocoque beta-hémolytique d’une substance qui, associée à un facteur plasmatique, produit une fibrinolyse marque la naissance de la thrombolyse. La streptokinase purifiée administée par voie intraveineuse permet de confirmer la responsabilité du thrombus dans l’occlusion coronaire. Un activateur tissulaire du plasminogène activant spécifiquement le plasminogène fixé au thrombus permet une thrombolyse locale. Cet activateur tissulaire du plasminogène (t-PA) sera produit par recombinaison génetique (rt-PA) et deviendra la référence pour la reperfusion coronaire et ensuite le premier traitement de l’accident vasculaire cérébral ischémique aigu, diminuant l’invalidité résiduelle. La thrombolyse a transformé les accidents vasculaires aigus en urgences médicales et a nécessité l’adaptation des procedures de prise en charge et la formation d’unités de soins spécialisés. La thrombolyse demeure la pierre angulaire des strategies de reperfusion vasculaires qui evoluent vers une individualisation sur les caracteristiques du patients, des délais estimés et des ressources locales.
Evidence from a beta hemolytic streptococcus substance which, in association to a plasma factor induces fibrinolysis was the birth of thrombolysis. Purified streptokinase intravenously administered confirmed the occluding role of the thrombus in coronary arteries. A tissue plasminogen activator specifically activating the thrombus bound plasminogen allows local thrombus fibrinolysis. The tissue plasminogen activator (t-PA) produced by recombinant genetic engineering technology (rt-PA) has become the reference pharmacological agent for coronary reperfusion and subsequently the first pharmacological treatment for acute ischemic stroke, decreasing patient disability. Thrombolysis has made acute vascular occlusions medical urgencies and has induced processes of care adaptation and setting up of treatment specific units. Thrombolysis remains the cornerstone of vascular reperfusion strategies which are evolving towards patient’s individualization, considering patient’s characteristics, estimated delays and local resources.
Thierry Danays M.D.
Key words: thrombolysis, fibrinolysis, history.
Thierry Danays M.D.
Mots clés: Embolie pulmonaire, Thrombectomie, percutané, choc hemodynamique
Evidence from a beta hemolytic streptococcus substance which, in association to a plasma factor induces fibrinolysis was the birth of thrombolysis. Purified streptokinase intravenously administered confirmed the occluding role of the thrombus in coronary arteries. A tissue plasminogen activator specifically activating the thrombus bound plasminogen allows local thrombus fibrinolysis. The tissue plasminogen activator (t-PA) produced by recombinant genetic engineering technology (rt-PA) has become the reference pharmacological agent for coronary reperfusion and subsequently the first pharmacological treatment for acute ischemic stroke, decreasing patient disability. Thrombolysis has made acute vascular occlusions medical urgencies and has induced processes of care adaptation and setting up of treatment specific units. Thrombolysis remains the cornerstone of vascular reperfusion strategies which are evolving towards patient’s individualization, considering patient’s characteristics, estimated delays and local resources.
Thierry Danays M.D.
Key words: thrombolysis, fibrinolysis, history.
Thierry Danays M.D.
Mots clés: Embolie pulmonaire, Thrombectomie, percutané, choc hemodynamique