Abstract
Thrombolytic therapy (TLT), as a method of treatment, began to develop in the second half of the 50s of the last century. At that time, there was an accumulation of data on its effectiveness, side effects and contraindications, as well as the development of fibrinolytic drugs, such as fibrinolysin, streptokinase, urokinase, and the conditions for their administration. Official recognition of TLT in regulatory documents began only in the 80s after the development of more effective and safe tissue plasminogen activators. However, on the threshold of an era of development in this area in the treatment of patients with thrombosis of the coronary, carotid, and other peripheral vascular regions, the researchers obtained conflicting data on the results of the use of thrombolytics. There was no concept of a therapeutic window for the use of TLT, there was no data on possible combinations of thrombolytic drugs with anticoagulants, the high probability of bleeding prevented widespread introduction of the method into clinical practice. At that time, vascular imaging and laboratory diagnostics were not sufficiently developed, there was no consensus of the world's leading experts on the benefits of thrombolysis. The use of TLT in acute arterial thrombosis required not only clinical experience, but also courage and ability to make non-standard decisions. The authors of the article analyze in detail the case of rescuing a patient with progressive thrombotic occlusion of the arteries of the brain stem. Then the pioneer in the field of thrombolytic therapy E. I. Chazov and his colleagues took responsibility for the application in this situation of an insufficiently studied treatment method with uncertain consequences. This decision was not due to the identity of the patient or the threat of an internal investigation. Marshal or soldier - it did not matter for E. I. Chazov and his colleagues. If doctors in this clinical situation relied on recommendations, orders and standards, then such a patient would have to wait thrombolysis for another 30 years.
Highlights
ТЛТ в последующие 2 дня была поддержана лечебными дозами гепарина под контролем времени свертывания крови с переходом на минимальные дозы непрямых антикоагулянтов по 150 мг / сут
В статье рассмотрен один клинический случай, документальное подтверждение которого стало доступно для исследователей через 50 лет после того, как было принято трудное решение о проведении тромболизиса больному с прогрессирующим тромбозом артерий ствола головного мозга
Summary
В то же время у врачей впервые появился способ восстановления кровообращения при тромботической окклюзии артерии миокарда или мозга, что открывало новые перспективы для больных, которым раньше, кроме покоя и симптоматического лечения, предложить было нечего. Консилиум врачей пришел к выводу, что у больного нарушение кровообращения в стволе мозга ишемического характера, однако рекомендовал воздержаться от применения антикоагулянтов и фибринолизина в связи с высоким уровнем АД. Впервые дни лечения в стационаре нарушения кровообращения в стволе головного мозга определяли клиническую картину болезни. ТЛТ в последующие 2 дня была поддержана лечебными дозами гепарина под контролем времени свертывания крови с переходом на минимальные дозы непрямых антикоагулянтов (пелентан – этил бискумацетат) по 150 мг / сут.
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