Thrombolytics

Question 1

What is an example of a thrombolytic?

Answer 1

• Tissue plasminogen activator

Question 2

What is the method of action of thrombolytics?

Answer 2

• Catalyse conversion of plasminogen → plasmin
• Plasmin breaks down fibrin = dissolves clots
• Reopens vessels and reperfusion of tissues

Question 3

What are the indications for thrombolytics?

Answer 3

• Acute ischemic stroke – given within 4.5h of onset
• Acute ST elevation MI – given within 12 hours of onset in combination with antiplatelet and anticoagulant
• Massive PE with haemodynamic instability

Question 4

What are the contraindications for thrombolytics?

Answer 4

• Recent haemorrhage – e.g. intercranial haemorrhage
• Recent trauma/surgery
• Bleeding disorders
• Severe hypertension
• Peptic ulcers
• Previous streptokinase treatment (another clot buster)

Question 5

What are the side effects of thrombolytics?

Answer 5

• Nausea/vomiting
• Bruising around injection site
• Hypotension
• Bleeding – treatment should be stopped
• Cardiogenic shock/cardiac arrest – treatment should be stopped
• Cerebral oedema – reperfusion injury – treatment should be stopped
• Arrhythmias – reperfusion injury

Question 6

What are the interactions with thrombolytics?

Answer 6

• Anticoagulant/antiplatelet drugs - ↑ risk of bleeding

* ACE inhibitors - ↑ risk of anaphylactic reaction

Question 7

What organ eliminates thrombolytics?

Answer 7

Kidney

Question 8

What patient information should be given to patients having thrombolysis?

Answer 8

• More likely to work the sooner it is given

* Doesn’t always work or may be temporary