Thrombolyse

Cet article est une ébauche concernant la médecine.

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La thrombolyse consiste à lyser (désagréger) par médicament les thrombus (caillots sanguins) obstruant les vaisseaux sanguins. Ce traitement reproduit de façon artificielle le phénomène physiologique de fibrinolyse.

Indications

Les trois principales indications de ce traitement d'urgence sont l'embolie pulmonaire[1], l'infarctus du myocarde et l'accident vasculaire cérébral ischémique[2],[3].

Traitement classique de première intention des infarctus du myocarde récent, il est réservé aux formes sévères des embolies pulmonaires, et tend à se généraliser dans la prise en charge précoce (premières heures[4],[3]) des AVC ischémiques peu étendus. Le bénéfice attendu de ce traitement d'urgence est la reperfusion tissulaire d'aval, en vue d'améliorer le pronostic fonctionnel et vital, mais au prix d'un risque incompressible d'hémorragies rares mais redoutables.

En pratique, le produit est injecté par voie veineuse périphérique ou intra-artérielle sélective.

Historique

Un professeur de médecine, William Tillet (en) (1892-1974)[5], découvre presque par hasard en 1933 qu'un enzyme appelé streptokinase peut dissoudre un caillot de sang. D'autres découvertes ont été faites par la suite à ce sujet. Une grande étude auprès de 11 000 patients a été publiée en 1986 par The Lancet[6].

Médicaments thrombolytiques

Fibrinolyse (schéma en anglais).

Mode d'action

Ces médicaments miment l'action de l'urokinase et de l'activateur tissulaire du plasminogène naturels (protéines de la fibrinolyse qui activent le plasminogène en plasmine).

Effets secondaires

Le risque principal est celui d'une hémorragie (tout saignement important ou toute chirurgie récente contre-indiquent la thrombolyse).

Il existe aussi un risque allergique avec la streptokinase.

Références

  1. ↑ a et b (en) N. Meneveau, F. Schiele, A. Vuillemenot, B. Valette, G. Grollier, Y. Bernard et J.-P. Bassand, « Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction », European Heart Journal, vol. 18, no 7,‎ , p. 1141-1148 (PMID 9243149, DOI 10.1093/oxfordjournals.eurheartj.a015410, lire en ligne)
  2. ↑ a et b Olivier Bill Patrik Michel Isabelle Peytremann-Bridevaux I. Peytremann-Bridevaux M. Rège Walther Bernard Burnand, « Efficacité de la thrombolyse dans l’AVC », Revue-Medicale-Suisse,‎ (lire en ligne)
  3. ↑ a et b « Efficacité de la thrombolyse dans l’AVC », sur Revue Medicale Suisse (consulté le )
  4. ↑ (en) N. Meneveau, F. Schiele, A. Vuillemenot, B. Valette, G. Grollier, Y. Bernard et J.-P. Bassand, « Thrombolysis for acute ischaemic stroke », dans Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, (DOI 10.1002/14651858.cd000213.pub2, lire en ligne), CD000213.pub2
  5. ↑ (en) « Dr. William S. Tillett, 81, Dies; Bacteriologist Led N.Y.U. Unit », The New York Times,‎ , p. 40 (lire en ligne)
  6. ↑ (en) « Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction », The Lancet,‎ (lire en ligne)

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