The Impact of the Fibrinolytic System on the Outcomes of Thrombolytic Therapy

Thrombolysis is one of the effectively used methods for treating patients with acute vascular pathology. Despite the high technical success of this therapy, some problems of fibrinolytic treatment still remain unresolved. Resistance to thrombolytic agents with subsequent unsatisfactory reperfusion of the vascular bed is the most important of them. Currently, despite advances in the pharmacotherapy of drugs used in thrombolysis and improvements in the technical basis for its performance, the predictors that influence its outcome are still not clearly defined. The use of fibrinolytic drugs during thrombolysis induces activation of the procoagulative component of hemostasis in the form of increased activity of thrombin, prothrombin fragments 1.2 and the thrombin-antithrombin III complex in response to excessive fibrinolysis caused by this treatment method. This paradoxical procoagulant activation of the hemostatic system may be the cause of the lack of initial reperfusion of the vascular bed in 15–25% of cases, and from 5% to 15% of cases of early thrombotic reocclusion after initially successful thrombolysis. In parallel with the activation of the coagulation link of hemostasis against the background of this type of treatment, changes occur in the functioning of the fibrinolysis system, which directly affects the outcomes of thrombolysis. This paper provides a comprehensive overview of the spectrum of major markers of the fibrinolytic system that have been studied in the context of thrombolysis outcomes in patients with acute vascular pathology. It was concluded that it is necessary to expand the determination of laboratory blood parameters by directly determining the values of plasminogen activator inhibitor-1, thrombin-activated fibrinolysis inhibitor, α2-plasmin inhibitor in order to predict the outcome of thrombolysis.