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Thrombolytic Drugs



  1. Non-specific
    Break pathological clot (e.g. Thromboemboli) as well as physiological fibrin (s/e Bleeding)
    S/E:  Risk bleeding are more.
  1. Streptokinase:
    1. Bacterial (streptococcal) product combined with plasminogen
    2. Activates thrombolysis by activating plasminogen
    3. Short acting drug
    4. Given intravenously
    5. Acts for 20-45 minutes
    6. Hypersensitivity is very common


  1. DOC for Acute Myocardial Infarction
    1. 1 Lakh IU followed by 60,000
    2. 3 Lakh followed by 1 Lakh


  1. Hypotension-MC
  2. Hypersensitivity (bacterial proteins)
  3. *Urokinase is a human enzyme synthesized by the kidney that directly converts plasminogen to active plasmin
  4. ( No hypersensitivity reactions)
  5. Bleeding
  1. Anistreplase
    Same as streptokinase only difference is acyl group is attached to increase its specificity. 
  2. Urokinase
    Obtained from human urine, so Hypersensitivity rarely seen.
  1. Specific (tissue Plasminogen Activators)
    Breaks only Pathological clots. These activators preferentially activate plasminogen that is bound to fibrin, which confines fibrinolysis to the formed thrombus and avoids systemic activation.
    1. Alteplase: Human t-PA manufactured by recombinant DNA
    2. Reteplase: less expensive congener
    3. Tenecteplase: Mutant form of t-PA, which is more Fibrin specific than t-PA.

*Extra edge

Most potent is tenecteplase.

Single Bolus injection is sufficient for thrombolysis



  1. Best result of thrombolysis within 30 min
  2. Up till 3 hrs thrombosis can be done
  3. Few study have shown, thrombolysis is effective up till 12 hrs.

C/I of thrombolysis:

  1. Absolute contraindications to the use of fibrinolytic agents include:
    1. history of cerebrovascular hemorrhage at any time
    2. nonhemorrhagic stroke or other cerebrovascular event within the past year
    3. marked hypertension (systolic arterial pressure >180 mmHg and/or a diastolic pressure >110 mmHg)
    4. suspicion of aortic dissection
    5. active internal bleeding (excluding menses).

Relative contraindications to fibrinolytic therapy:

  1. current use of anticoagulants (international normalized ratio 2)
  2. a recent (<2 weeks) invasive or surgical procedure or prolonged (>10 min) cardiopulmonary resuscitation
  3. known bleeding diathesis pregnancy
  4. hemorrhagic ophthalmic condition (e.g., hemorrhagic diabetic retinopathy)
  5. active peptic ulcer disease
  6. history of severe hypertension that is currently adequately controlled.
  7. Because of the risk of an allergic reaction, patients should not receive streptokinase if that agent had been received within the preceding five days to two years.




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