thrombolytic drugs n.
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Thrombolytic drugs
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  1. Thrombolytic drugs BY :DR. ISRAA OMAR

  2. FIBRINOLYSIS AND THROMBOLYSIS • It is initiated concomitantly with coagulation cascade, resulting in the formation of active plasmin ,which digest fibrin . • The main drug of this group are streptokinase and tissue plasminogen activator (tPA),for example alteplase • The main use is in acute STMI ,acute stroke, clearing cannula ,arterial thromboembolism and life threatening DVT and pulmonary embolism

  3. Thrombolytic drugs – mechanism of action

  4. Thrombolytic drugs – mechanism of action

  5. Thrombolytic drugs – mechanism of action

  6. Streptokinase • Is a non –enzyme protein extracted from culture of streptococci • It form stable complex with plasminogen and gains enzymic activity ;then causes fibrinolysis • The major adverse effect is bleeding include GI Hemorrhage and stroke • Hemorrhage can be treated with traneximic acid • Hypotension and hypersensitivity may also recorded

  7. Alteplase and duteplase • Both are recombinant tissue plasminogen activators. • Alteplase is a single chain where as duteplase is a double chain • They preferentially plasminogen that is bound to fibrin ,they are said to be clot selective . • They dissolve formed thrombus and avoid systemic activation of plasminogen • They can cause hemorrhage but less than streptokinase • No hyper sensitivity reaction occur with them

  8. Contraindications to thrombolytic therapy • Active internal bleeding • Bleeding diatheses • Pregnancy • Uncontrolled hypertension • CPR • Recent major surgery or Eye surgery • Recent hemorrhagic stroke

  9. TREATMENT OF BLEEDING BY:DR ISRAA OMAR

  10. Aminocaproic acid and traneximic acid • Both are synthetic agents • Work by inhibition of plasminogen activation • They are orally active • A potential side effect of treatment is intravascular thrombosis

  11. Aprotinin • It stops bleeding by blocking plasmin • It can inhibit streptokinase • It is used to reduce blood loss in patients undergoing cardiopulmonary bypass surgery • Side effect include anaphylactic reaction if there is previous exposure within 12 month , renal dysfunction is also reported with the use of this drug

  12. Protamine sulfate • Antagonizes the anticoagulant effect of heparin • It is derived from fish sperm and testes and has a high content of arginine which make it basic drug • It is positive charge neutralize the negative charge of heparin thus making a stable complex and prevent the action of heparin • Side effect include dyspnea , flushing , hypotension and bradycardia especially when injected rapidly

  13. Vitamin k (phytonadione) • It antagonize the action of oral anticoagulant • The action of vitamin k start after 24 hours; thus ,if immediate action is required ,fresh frozen plasma should be infused

  14. Thank you