Fibrinolytic Drugs

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Andrew Street
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Give eg's of & indications for fibrinolytic drugs. eg's: alteplase, streptokinase Indications: • Acute ischaemic stroke - alteplase improves prognosis if given within 4.5/24 of onset • Acute ST elevation MI - alteplase & streptokinase can reduce mortality when they are given within 12/24 of the onset of Sx in combination with antiplatelet agents & anticoagulants. However PPCI has largely superseded fibrinolytics in this. • Reduction of clot size & pulmonary pressures in massive PE with haemodynamic instability
MOA of fibrinolytic drugs. Fibrinolytic drugs, also known as thrombolytic drugs, catalyse the conversion of plasminogen to plasmin, which acts to dissolve fibrinous clots & re-canalise occluded vessels. This allows reperfusion of affected tissue, preventing or limiting tissue infarction & cell death & improving pt outcomes.
SE's of fibrinolytic drugs. • Nausea • Vomiting • Bruising around the injection site If the following SE's occur Rx must be stopped: • Serious bleeding • Allergic reaction • Cardiogenic shock • Cardiac arrest Reperfusion of infarcted brain or HT can lead to: • Cerebral oedema • Arrhythmias
CI's, cautions, & important interactions of fibrinolytic drugs. CI's: • Pt's at risk of bleeding - eg recent haemorrhage, recent trauma or surgery, bleeding disorders, severe HT, peptic ulcers • Following an acute stroke, intercranial haemorrhage must be excluded with a CT scan • Previous streptokinase Rx Cautions: • None Important interactions: The risk of haemorrhage is ^in pt's taking anticoagulants, & antiplatelet agents. ACE inhibitors appear to ^risk of anaphylactoid reactions.
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