Thrombolytic drugs BY :DR. ISRAA OMAR
Feb 12, 2016
Thrombolytic drugsBY :DR. ISRAA OMAR
It is initiated concomitantly with coagulation cascade, resulting in the formation of active plasmin ,which digest fibrin .
The main drug of this group are streptokinase and tissue plasminogen activator (tPA),for example alteplase
The main use is in acute STMI ,acute stroke, clearing cannula ,arterial thromboembolism and life threatening DVT and pulmonary embolism
FIBRINOLYSIS AND THROMBOLYSIS
Thrombolytic drugs – mechanism of action
Thrombolytic drugs – mechanism of action
Thrombolytic drugs – mechanism of action
Is a non –enzyme protein extracted from culture of streptococci
It form stable complex with plasminogen and gains enzymic activity ;then causes fibrinolysis
The major adverse effect is bleeding include GI Hemorrhage and stroke
Hemorrhage can be treated with traneximic acid Hypotension and hypersensitivity may also
recorded
Streptokinase
Both are recombinant tissue plasminogen activators.
Alteplase is a single chain where as duteplase is a double chain
They preferentially plasminogen that is bound to fibrin ,they are said to be clot selective .
They dissolve formed thrombus and avoid systemic activation of plasminogen
They can cause hemorrhage but less than streptokinase
No hyper sensitivity reaction occur with them
Alteplase and duteplase
1. Active internal bleeding 2. Bleeding diatheses 3. Pregnancy4. Uncontrolled hypertension 5. CPR6. Recent major surgery or Eye surgery 7. Recent hemorrhagic stroke
Contraindications to thrombolytic therapy
TREATMENT OF BLEEDING
BY:DR ISRAA OMAR
Both are synthetic agents Work by inhibition of plasminogen
activation They are orally active A potential side effect of treatment is
intravascular thrombosis
Aminocaproic acid and traneximic acid
It stops bleeding by blocking plasmin It can inhibit streptokinase It is used to reduce blood loss in patients
undergoing cardiopulmonary bypass surgery
Side effect include anaphylactic reaction if there is previous exposure within 12 month , renal dysfunction is also reported with the use of this drug
Aprotinin
Antagonizes the anticoagulant effect of heparin It is derived from fish sperm and testes and
has a high content of arginine which make it basic drug
It is positive charge neutralize the negative charge of heparin thus making a stable complex and prevent the action of heparin
Side effect include dyspnea , flushing , hypotension and bradycardia especially when injected rapidly
Protamine sulfate
It antagonize the action of oral anticoagulant
The action of vitamin k start after 24 hours; thus ,if immediate action is required ,fresh frozen plasma should be infused
Vitamin k (phytonadione)
Thank you