Changes in Fibrinolytic System after Continual Doppler Monitoring in Healthy Volunteers


Authors: D. Školo udík 1,3;  T. Fadrná 1;  M. Bar 1;  O. Zapletalová 1;  O. Zapletal 2;  J. Blatný 2;  K. Langová 3;  D. Šaňák 4;  M. Král 4;  R. Herzig 4;  P. Kaňovský 4
Authors‘ workplace: Neurologická klinika FN Ostrava, 2Oddělení klinické hematologi e, Dětská nemocnice FN Brno, 3Iktové centrum, Neurologická klinika LF UP a FN Olomo uc, 4Oddělení bi ometri e, Ústav lékařské bi ofyziky LF UP v Olomo uci 1
Published in: Cesk Slov Neurol N 2009; 72/105(5): 446-452
Category: Original Paper

Overview

Background:
In vitro and in vivo studies have demonstrated that ultrasonic waves at a frequency of 20 kHz–2 MHz enhance the lysis of thrombus brought on by thrombolytics. The aim of this study was to demonstrate that the application of continual 60-minute ultrasonic monitoring (sonothrombolysis, ST) using a transcranial 1–4-MHz probe brings on activation of a patient’s fibrinolytic system when monitoring both middle cerebral artery (MCA) and radial artery (RA).

Material and methods:

Thirty volunteers participated in the study and underwent ST of MCA (ST-MCA), ST of RA (ST-RA) and a standard neurosonological examination (SNE) at two-week intervals. The following parameters were examined prior to, 60 minutes and 24 hours after the ST-ACM, ST-AR and SNE: tissue plasminogen activator (tPA), PAI-1 antigen, α-2-antiplasmin (AP), plasminogen (PG), thrombocyte count, fibrinogen level, D-dimers, fibrin degradation products (FdP), fibrin monomers (FM), aPTT, prothrombin time, time of euglobulin lysis, osmolality, homocysteine and lipoprotein (a). Neurological and physical examination was done prior to, 60 minutes, 24 hours, 30 days and 90 days after ST-MCA, ST-RA and SNE. All adverse effects were recorded. An MR examination of the brain was done on all volunteers before the ST-MCA was started as well as 24 ± 4 hours after the end of monitoring. The paired Student’s t-test, a non-parametric Wilcoxon Signed rank-Test and Friedman’s ANOVA test were used to execute statistical assessment of the changes in values of the monitored parameters.

Results:
Following the ST-ACM there was a significant decrease in PAI-1 antigen of 26.6%, in AP activity of 5.1%, in PG activity of 4.3% and in tPA antigen of 7.1%. Following the ST-Ar there was a significant decrease in PAI-1 of 16.8%, in AP activity of 3.3%, and in PG activity of 6.7%. Following the SNe there were no significant changes in any of the monitored parameters. The MR examination of the brain did not demonstrate any detectable changes compared to the initial examination in any of the volunteers.

Conclusion:
Transcranial Doppler monitoring of the flow capacity of brain and upper limb vessels by way of a diagnostic duplex transcranial probe leads to a direct effect of the fibrinolytic system accompanied by a decrease in the level of fibrinolysis inhibitors.

Key words:
ultraso und –  tre atment –  fibrinolytic system –  transcrani al Doppler –  transcrani al probe


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Labels
Paediatric neurology Neurosurgery Neurology
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