Monitoring of haemostatic parameters during thrombolysis with rtPA for deep venous thrombosis: correlation with clinical events

Abstract

In a substudy on patients undergoing thrombolytic therapy for deep venous thrombosis with different doses of recombinant tissue-type plasminogen activator (Alteplase; Actilyse®, Boehringer Ingelheim, Germany) within a multi-centre trial, several haemostatic parameters were determined serially in an attempt to correlate changes of these parameters with clinical events, such as therapeutic outcome and bleeding complications.

The main finding of our study was that the consumption of the inhibitors of fibrinolytic activity, PAI-1 and plasmin-inhibitor (formerly α2-antiplasmin) during continuous thrombolysis for deep venous thrombosis was associated with a significant increase of bleeding complications. In addition we found a trend towards lower recanalization rates and more frequent bleeding complications in patients with enhanced activation of the plasmatic coagulation system, reflected by higher concentrations of the activation peptides thrombin-antithrombin-complex, fibrin(ogen)-degradation-product and d-dimer.

As bleeding represents the major limitation to a wider application of thrombolytic therapy in deep vein thrombosis it might be worthwhile to evaluate a concept of individualized thrombolytic therapy, adjusted for parameters associated with enhanced bleeding risk and low recanalization rates.