Definition of "Thrombolytic"
Last modified: 19 hours
It's drugs that you use to dissolve blood clots.
Whenever there's a blockage. Because this can cause permanent damage to tissue. So when the heart or brain can't get the blood it needs. Or there's a clot in the leg or lungs.
Yeah, you give it with things to help PREVENT clots in the future. So anticoagulants. They work well together
.
When there's bleeding in the brain. Obviously.
Thrombolytic (aka clot busters) are drugs used to induce thrombolysis (i.e. dissolve blood clots by pharmacological means).
Patient information
What is thrombolysis?It's drugs that you use to dissolve blood clots.
So wait. Is that the same as anticoagulant, or an antiplatelet?
No. Antiplatelets decrease platelet aggregation, so PREVENTS clots from forming. Anticoagulants similarly, just PREVENT clots from forming. So the difference is that thrombolytics are meant to actively dissolve clots.
Purpose
- To clear a blocked artery and avoid permanent damage to the perfused tissue (e.g. myocardium, brain, leg) and death, as in the Tx of:
- MI (heart attack)
- Thromboembolic strokes
- DVT
- PE
- Clear blocked catheters, that are used in long-term Tx
Patient information
When do you proactively dissolve blood clots, rather than try prevent them?Whenever there's a blockage. Because this can cause permanent damage to tissue. So when the heart or brain can't get the blood it needs. Or there's a clot in the leg or lungs.
Indications
- Most effective if administered IMMEDIATELY after it has been determined they are clinically appropriate. Advantage of administration is highest <60 mins after a thrombotic event, but the window may extent UP TO 6 hours after the start of Sx
- Often administered in combination w/ anticoagulants (e.g. IV heparin or LMWH), for synergistic antithrombotic effects and secondary prevention
Patient information
Do you proactively dissolve blood clots by itself, or do you give other things too?Yeah, you give it with things to help PREVENT clots in the future. So anticoagulants. They work well together
.Contraindications
- Hemorrhagic strokes, as it's use in that situation would prolong bleeding into the intracranial space, and cause further damage
Patient information
When would you NOT proactively dissolve blood clots?When there's bleeding in the brain. Obviously.
MOA
- They limit the damage caused by the blockage or occlusion of a blood vessel
- They are all protease enzymes, which through bond cleavage, catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown
- Works by stimulating secondary fibronolysis by plasmin through infusion of analogs of tPA (tissue plasminogen activator), the protein that normally activates plasmin
Classification
- tPA (tissue plasminogen activator), including:
- Alteplase (Activase)
- Reteplase (Retavase)
- Tenecteplase (TNKase)
- Streptokinase (Streptase)
- Anistreplase (Eminase)
- Urokinase (Abbokinase)
Side effects
- Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy
- If a Pt has had thrombolysis before, an allergy against the thrombolytic drug may have developed, ESPECIALLY after streptokinase. If the Sx are mild, the infusio is stopped and the Pt is commenced on an antihistamine before infusion is recommenced. Anaphylaxis generally requires immediate cessation of thrombolysis
See also
Synonyms:
Abbokinase
Activase
Alteplase
Anistreplase
Eminase
Retavase
Reteplase
Streptase
Streptokinase
Tenecteplase
Thrombolysis
Thrombolytic agent
Thrombolytic drug
Tissue plasminogen activator
TNKase
tPA
Urokinase
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