Experience in the use of non-immunogenic recombinant staphylokinase in the treatment of massive pulmonary embolism

Abstract

The actuality of the problem of pulmonary embolism is due to the widespread occurrence of this complication with unpredictable consequences, including hemodynamic instability, arterial hypotension, shock, disability and sudden death. Pulmonary embolism is now considered in developed countries as the most common cause of preventable inhospital death and maternal mortality. Thrombolytic therapy is used for intermediate and high-risk pulmonary embolism with hemodynamic instability of the patient, however, there is also ongoing discussion about the possibilities of its implementation in normotensive patients under certain conditions. Currently, streptokinase, urokinase and alteplase (Actilize and Revelise in Russia) are used for thrombolytic therapy of pulmonary embolism. Indications for use in pulmonary embolism have been expanded recently for the already wellknown domestic thrombolytic non-immunogenic staphylokinase (Fortelizin®), which has proven itself in patients with acute myocardial infarction and acute ischemic stroke. A clinical case of delayed (on the 4th day of hospitalization) use of Fortelisin with a positive effect in a 49-year-old normotensive anemized patient with syncope in the PE debut with non-occlusive thrombosis of the posterior tibial veins without flotation of blood clots is presented. The features of Fortelizin, which favorably distinguish it from other thrombolytic agents, are: the highest fibrin selectivity; the possibility of bolus administration of a fixed dosage, independent of the patient’s body weight; safety of repeated administration; high rate of onset of effect; prevention of a significant decrease in blood fibrinogen levels, which reduces the risk of bleeding. Thus, the use of the domestic thrombolytic recombinant non-immunogenic staphylokinase drug Fortelizin, taking into account the data of the conducted studies and the described case, seems to be a successful example of import substitution in medicine.