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