Thrombolytics/ Fibrinolytics

Question 1

Name some common fibrinolytics

Answer 1

Streptokinase and Altepase

Question 2

How do fibrinolytics work?

Answer 2

Plasmin breaks down the fibrin clot
Fibrinolytics catalyse the conversion of plasminogen to plasmin
As a result plasmin dissolves fibrinous clots and re-canalises occluded vessels

Question 3

What are the main uses for fibrinolytics?

Answer 3

1. Stroke (better prognosis if used within 4.5 hours)
2. MI - acute ST elevation MI along with antiplateles within 12 hours (PCI has superseded fibrinolytics)
3. Massive PE - PE with haemodynamic instability

Question 4

What are the contraindications of using fibrinolytics?

Answer 4

Bleeding disorders (thrombocytopenia/haemophillia)
Peptic Ulcer
Unstable hypertension
Trauma/Sugery
Intracranial haemorrhage (needs to be excluded by CT)
Previous streptokinase treatment

Question 5

What are the interactions with fibrinolytics?

Answer 5

Risk of bleeding if used with other anticoagulants/antiplatelets
ACE inhibitors increase the risk of anaphylaxis

Question 6

What are the side effects of fibrinolytics?

Answer 6

Nausea and vomiting
Bruising at injection site
Hypotension
Bleeding, allergic reactions, cariogenic shock and cardiac arrest requires treatment to be stopped

Question 7

Are fibrinolyitcs commonly given?

Answer 7

Given with caution

Only by specialist