Fibrinolytics

General¶

• Degrade thrombi
• Systemic administration: Acute MI, Acute Ischemic stroke, most Massive PE
• Catheter based: Peripheral arterial thrombi, proximal deep veins
• Drugs
  • All convert plasminogen to plasmin (zymogen to enzyme)
    • Degrades fibrin matrix
  • rtPA, alteplase
    • fibrin specific, plasminogen bound, activated (converts to plasmin)
    • higher fibrin affinity, works better around clots
    • \<75 w/\<6h of symptoms of Acute MI, Iv for 1-1.5h
  • Nonspecific – fibrin bound and circulating plasminogen activation – plasmin can cause lytic state
    • Streptokinase – no fibrin affinity
      • IV for Acute MI – reduce mortality
        • hypotension
    • Urokinase – not immunogenic, catheter lysis of thrombi