Thrombolytics agents

It is also called as fibrinolytic therapy

1. Thrombolytic agent is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. The thrombolytic agents available today are serine proteases that work by converting plasminogens to the natural fibrinolytic agent plasmin. Plasmin lyses clot by breaking down the fibrinogen and fibrin contained in a clot.

2. DEFINITION Thrombolysis is a process or a form of treatment with a primary goal of the dissolving blood clots that cause obstruction. This is a common form of treatment that can assist clients who are suffering from blood clots. This can also facilitate improvement of one’s blood flow.

3. Streptokinase: ST elevation myocardial infarction Arterial thrombosis DVT Pulmonary embolism Intra- arterial or intravenous catheter occlusion

4. History of chronic, severe, poorly controlled hypertension. History of prior ischemic stroke Dementia Recent internal bleeding No compressible vascular punctures Pregnancy Current use of an anticoagulant (warfarin)

5. Fibrinolytic agents are divided into 2 categories: fibrin- specific agents Non- fibrin- specific agents

6. Fibrin- specific agents : include alteplase (tPA), reteplase (recombinant plasminogen activator [r-PA], and tenecteplase produce limited plasminogen conversion in the absence of fibrin. Non-fibrin specific agents: eg: streptokinase catalyze systemic fibrinolysis.

7. The most commonly used clot-busting drugs also known as thrombolytic agents include: Eminase (anistreplase) Retavase ( reteplase) Sreptase (streptokinase) T-PA TNKase abbokinase

8. THROMBOLYSIS USES There are a number of uses of the thrombolytic agents in a specific manner. The following are the said uses of the drugs: STREPTOKINASE The said agent will remain in the patient’s body and provide a chronic or lasting treatment for three to six months. ST elevation in myocardial infarction. This is found or identified in ECG results. Those who had an ST elevation are required to take such medication. Those suffering from arterial thrombosis and deep vein thrombosis. These are common conditions of the elderly and those who are prone to blood clot formation. Patients with acute pulmonary embolism are treated with streptokinase

9. TENECTEPLASE This is modified form of tPA or tissue plasminogen activator that shall convert plasminogen to plasmin. Those suffering from an acute MI or myocardial infarction are provided with such medication

10. UROKINASE This type of thrombolytic agent has a number of uses. This is provided to clients who have had myocardial infarction. Occlusion of a catheter can be treated with this drug. Deep vein thrombosis is also relieved by this drug. During dialysis this drug is used to avoid or be a form of prophylaxis for thrombus formations

11. THROMBOLYSIS MECHANISM The basic action of thrombolysis is to dissolve the formed blood clots or clinically known as lysing the thrombi. As an agent is administered, it would start its role by activating plasminogen. Plasmin is capable in breaking down the integrity of the blood clot formation. Plasminogen would serve as an activator and assistance in the process of thrombosis. Plasmin is capable of breaking down the molecules responsible in holding together the blood clot, known as the fibrin molecules. As the action of plasmin is taken part, breaking down the clot formations is easily attained.

12. T-PA Acute myocardial infarction Acute cerebrovascular thrombosis Pulmonary embolism Central venous catheter occlusions

13. Thrombolysis Guidelines It would involve its use and indications. This is not provided abruptly as one is suspected to be problems with blood clot formation. There are indications to be considered before prescribing the drug. This is to make precautions as this drug is not to be abused.

14. Non- cardiogenic pulmonary edema Hypotension Fever and shivering History of cerebrovascular hemorrahage marked hypertension (SAP> 180mm of hg/ DAP> 110 mm of hg) Suspicion of aortic dissection Active internal bleeding

15. Severe high blood pressure Active bleeding or severe blood loss hemorrhagic stoke from bleeding in the brain. Severe kidney disease Recent surgery Bruising or bleeding at the access site Damage to the blood vessel Migration of the blood clot to another part of vascular system. Kidney damage in pts with diabetes.