The mechanism and incidence of bleeding in patients undergoing fibrinolytic therapy are discussed, the role of laboratory findings in predicting the patient's clinical course is described, and guidelines concerning patient management are presented. Plasminogen activators have more similarities than differences in the mechanisms by which they dissolve thrombi and hemostatic plugs and, therefore, in their potential for vascular reperfusion or bleeding complications. The duration of an active lytic state in the blood varies according to the half-life of the activator; regardless of the agent chosen, however, plasma fibrinogen concentrations do not return to normal levels for one to two days following treatment. If plasminogen activator is still circulating, control of surgical bleeding after plasminogen activator treatment requires correction of the low plasma fibrinogen concentration with cryoprecipitate and administration of antifibrinolytic agents. Tests of coagulation and fibrinolysis can demonstrate a lytic state during therapy, but manipulation of drug therapy based on laboratory results is unlikely to control the patient's clinical course. Safe and effective therapy with plasminogen activators depends more on clinical judgment than on strict interpretation of laboratory test results.

 

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