milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2026.4.88milmed-804Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПредтромболитическая подготовка при ишемическом инсульте: забыть нельзя использоватьPre-thrombolytic preparation for ischemic stroke: forget cannot useБойкоА. В.BoikaA. V.КейзероваС. И.KeizerovaS. I.

г. Минск

Minsk

Институт повышения квалификации и переподготовки кадров здравоохранения учреждения образования, «Белорусский государственный медицинский университет»БеларусьInstitute for Advanced Training and Retraining of Healthcare Personnel of the «Belarusian State Medical University»BelarusУЗ «5-я городская клиническая больница»Беларусь«5th City Clinical Hospital»Belarus202627102026048894Copyright © Бойко А.В., Кейзерова С.И., 20262026Бойко А.В., Кейзерова С.И.Boika A.V., Keizerova S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/804

Совершенствование диагностических и лечебных мероприятий, направленных на повышение эффективности тромболитической терапии (ТЛТ) инфаркта мозга (ИМ), является актуальной задачей современной ангионеврологии. Современные научные данные свидетельствуют о том, что определение  показаний и противопоказаний к проведению ТЛТ представляет собой многоэтапный процесс, основанный на фундаментальном принципе «время-здоровье мозга». В обзоре представлены современные рекомендации и актуальные научные сведения, отражающие текущие подходы к оптимизации процессов диагностики и лечения состояний, ассоциированных с неблагоприятными исходами после тромболизиса. Особое внимание в статье уделено стратификации риска геморрагической трансформации зоны инфаркта  по результатам ряда лабораторных показателей (количество тромбоцитов, МНО, фибриноген, D-димер, отношение абсолютного числа нейтрофилов к лимфоцитам, гликемия, креатинин) до начала ТЛТ. Приводятся примеры лабораторных данных, определенная динамика которых может с высокой долей вероятности прогнозировать неблагоприятный исход после завершения ТЛТ в первые 24 часа. Показана необходимость регулярных научных исследований, направленных на совершенствование диагностики  и лечения патологических процессов, ассоциированных с неблагоприятным исходом ТЛТ. Обосновывается и предлагается к широкому использованию термин «предтромболитическая подготовка» для четкого определения комплекса диагностических и лечебных мероприятий, направленных не только на определение показаний и противопоказаний к применению этиопатогенетически обоснованных аппаратных  и/или медикаментозным методов лечения ИМ, но и для разработки новых эффективных методов ранней диагностики и лечения перед назначением ТЛТ, одновременно с проведением ТЛТ и в течение 24 часов после завершения ТЛТ.

Pressing issue in modern angioneurology is an improving diagnostic and therapeutic measures aimed at increa sing the effectiveness of thrombolytic therapy for cerebral infarction. Modern scientific data indicate that determining indications and contraindications for TLT is a multi-stage process based on the fundamental principle of «time is brain health.» This review presents current recommendations and scientific data reflecting approaches to optimizing the diagnosis and treatment of conditions associated with adverse outcomes after thrombolysis. Particular attention is paid to risk stratification for hemorrhagic transformation of the infarct zone based on the results  of several laboratory parameters (platelet count, INR, fibrinogen, D-dimer, absolute neutrophil to lymphocyte  ratio, glycemia, creatinine) before the start of thrombolytic therapy (TLT). Examples of laboratory data are given, the specific dynamics of which can, with a high degree of probability, predict an unfavorable outcome after completion of TLT in the first 24 hours. The need for regular scientific research aimed at improving the diagnosis and treatment of pathological processes associated with adverse outcomes after TLT is demonstrated. The term «pre-thrombolytic preparation» is substantiated and proposed for widespread use to clearly define a set of diagnostic and therapeutic measures aimed not only at determining the indications and contraindications for the use of etiopathogenetically substantiated hardware and/or drug methods for the treatment of MI, but also for the development of new methods for early diagnosis and treatment before prescribing thrombolytic therapy, simultaneously with thrombolytic therapy and within 24 hours after completion of thrombolytic therapy.

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The authors declare that there are no conflicts of interest present.