Thrombolytics - Tissue Plasminogen

Question 1

what is alteplase used for?

Answer 1

• acute ischaemic stroke (if given within 4.5h of onset increases chance of independant living)
• acute STEMI alteplase and streptokinase reduce mortality when given within 12hs of onset
• massive PE with haemodynamic instability (reduced clot size and pulmonary artery pressure)

Question 2

how do thrombolytics like alteplase and streptokinase work?

Answer 2

they are fibrinolytic drugs that catalyse the conversion of plasminogen to plasmin which acts to dissolve fibrinous clots and re-canalise occluded vessels.

Question 3

what are the side effects of thrombolytic drugs such alteplase and streptokinase?

Answer 3

• nausea / vomiting
• bruising
• hypotension

Stop drug if:

• allergic reaction
• cardiogenic shock
• cardiac arrest

-reperfusion of infarcted brain or heart tissue can cause cerebral oedema and arrhythmias

Question 4

what are the contraindications to thrombolytics such as alteplase and streptokinase?

Answer 4

• bleeding (haemorrhage or surgery)
• bleedng disorders
• severe hypertension
• peptic ulcers
• haemorrhagic stroke
• previous streptokinase treatment - cannot use same drug again

Question 5

what are the drug interactions of thrombolytics?

Answer 5

• antigoagulants / antiplatelets –> increase risk of haemorrhage
• ACE inhibitors

Question 6

how are fibrinolytics given (route)

Answer 6

IV bolus then infusion

only available as injectable forms