Fibrinolytics

Question 1

Mechanism of action?

Answer 1

Thrombolytic drugs, catalyze the conversion of plasminogen to plasmin which dissolves fibrinous clots &re-canalizes occluded vessels. Allowing perfusion of the affected area &limiting tissue infarction.

Extremely potent drugs, only put to use when vital prognosis is in question. Always asso to Heparin.

Question 2

Indications?

Answer 2

• Acute ischemic stroke, it increases chances of living independently if given within 4/5 hours of the onset of stroke symptoms.
• Massive pulmonary embolism with hemodynamic instability, they reduce clot size &pulmonary artery pressure.

Syndrome coronarien aigue et embolie pulmonaire massive ac choc cardiogenique.

Question 3

How are fibrinolytic drugs taken?

Answer 3

Exclusively in IV bolus or IV perfusion, short half-life. Risk of death is increased intially after receiving clot-busting drugs (=fibrinolytics/thrombolytics), after the first week the chances of living independently are increased. Verbal consent is needed before choosing to introduce the treatment, in cases of neurological impairment, physician may use clot-busting drugs if judged in the patient’s best interests.

Question 4

Name Fibrinolytic drugs?

Answer 4

Alteplase, Streptokinase, Urokinase, Reteplase, Tenecteplase, L’activateur tissulaire de plasminogene.

Question 5

Important AE?

Answer 5

Nausea &vomiting, bruising around the site of injection. Serious AE that require discontinuation : serious bleeding, allergic reactions, cardiogenic shock, cardiac arrest.