Cleveland Clinic journal of medicine
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Review Comparative Study
New fibrinolytic agents for MI: as effective as current agents, but easier to administer.
The efficacy and safety of fibrinolytic agents have not dramatically changed since alteplase (Activase), a derivative of tissue plasminogen activator (t-PA), was introduced nearly 2 decades ago. However, newer agents have a longer half-life, making them easier to deliver. Fibrinolytic therapy is underused in many patients, especially in those traditionally thought to be at high risk for complications.
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The history and physical examination, rather than routine laboratory, cardiovascular, and pulmonary testing, are the most important components of the preoperative evaluation. The history should include a complete review of systems (especially cardiovascular and pulmonary), medication history, allergies, surgical and anesthetic history, and functional status.
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The use of HS solutions has been shown to reduce ICP both in animal models and in human studies in a variety of underlying disorders, even in cases refractory to treatment with hyperventilation and mannitol. There are several possible mechanisms of action, and important complications such as central pontine myelinolysis and intracranial hemorrhage have not been reported in the human studies. Different types of HS solutions with different methods of infusion (bolus and continuous) have been used in the past, and so far there are not enough data to recommend one concentration over another. Many issues remain to be clarified, including the exact mechanism of action of HS, the best mode of administration and HS concentration to be given, and the relative efficacy of HS vis-à-vis available treatments, particularly mannitol.