Thrombolytic drugs
Thrombolytic drugs are used to dissolve a preexisting clot or thrombus, often in an acute or emergency situation.
Some of thethrombolytic drugs currently
used include alteplase, reteplase,streptokinase, tenecteplase, and
urokinase.
After I.V. or intracoronary administration,
thrombolytic drugs are distributed immediately throughout the circulation,
quickly acti-vating plasminogen (a precursor to plasmin, which dissolves fibrin
clots).
Alteplase, reteplase, tenecteplase, and urokinase
are cleared rap-idly from circulating plasma, primarily by the liver.
Streptokinase is removed rapidly from the circulation by antibodies and the
reticuloendothelial system (a body system involved in defending against
infection and disposing of products of cell breakdown). These agents don’t
appear to cross the placental barrier.
Thrombolytic drugs convert plasminogen to plasmin,
which lyses (dissolves) thrombi, fibrinogen, and other plasma proteins. (See How alteplase helps restore circulation)
Thrombolytic drugs have a number of uses. They’re
used to treat certain thromboembolic disorders (such as acute MI, acute
is-chemic stroke, and peripheral artery occlusion) and have also
Thrombolytic drugs are the drugs of choice to break
down newly formed thrombi. They seem most effective when administered within 6
hours of the symptoms onset.
In addition, each drug has specific uses.
§ Alteplase is used to treat acute MI,
pulmonary embolism, acute ischemic stroke, peripheral artery occlusion, and to
restore paten-cy to clotted grafts and I.V. access devices.
§ Streptokinase is used to treat acute MI, pulmonary
embolus, and DVT.
§ Reteplase and tenecteplase are used to treat
acute MI.
§ Urokinase is used to treat pulmonary embolism
and coronary artery thrombosis and for catheter clearance.
·
Thrombolytic drugs interact with heparin, oral anticoagulants,
antiplatelet drugs, and NSAIDs to increase the patient’s risk of bleeding.
·
Aminocaproic acid inhibits streptokinase and can be used to re-verse its
fibrinolytic effects. (See Adverse
reactions to throm-bolytic drugs.)
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