Fibrinolytics and antifibrinolytics
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Fibrinolytics such as streptokinase, urokinase, and alteplase work by activating the natural fibrinolytic system to lyse thrombi and recanalize occluded blood vessels. They activate plasminogen to plasm in order to dissolve blood clots through the process of fibrinolysis. Streptokinase is the least expensive but also the least specific and can cause allergic reactions. Urokinase is non-antigenic and adverse effects are rare. Alteplase is fibrin-specific, rapid-acting, and has a lower risk of bleeding but is more expensive. Fibrinolytics are used to treat conditions like myocardial infarction, deep vein thrombosis, and pulmonary
Fibrinolytics and antifibrinolytics
- 1. By Dr. Md Yaqub
- 2. These are the drugs used to lyse thrombi/ clot to recanalize occluded blood vessels (mainly coronary artery). They act by activating natural fibrinolytic system
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- 4. • The process of dissolution of clot is called fibrinolysis • Egs:- Streptokinase • Urokinase • Alteplase • Reteplase • Tenecteplase
- 6. Streptokinase Obtained from -hemolytic streptococci group C. Binds with circulating plasminogen to form complex that activates plasminogen to plasmin Its non fibrin specific. i.e. activates both circulating as well as fibrin bound plasminogen. Predisposes to bleeding It is least expensive
- 7. It is destroyed by circulating antistreptococcal antibodies Stk is antigenic- hypersensitivity reaction, anaphylaxis in 1-2%. Adverse effects:- Fever, hypotension, allergic reactions, arrhythmias can occur.
- 8. Urokinase human urine, human kidney cells. Non antigenic, not destroyed by antibodies. Adverse effects:-Hypotension and allergic phenomenon are rare. Fever can occur
- 9. Alteplase (rt-PA) recombinant DNA technology fibrin specific Non antigenic, non-pyrogenic, not destroyed by antibodies, Rapid acting, more potent Nausea, mild hypotension, fever may occur More effective, more Expensive Low risk of bleeding and allergic reactions
- 10. USES of fibrinolytics 1. ACUTE MYOCARDIAL INFARCTION
- 11. 2. Deep vein thrombosis 3. Pulmonary embolism
- 12. 4.Peripheral arterial occlusion 5. Acute Ischemic Stroke
- 13. Contraindications to thrombolytic therapy 1. Intracranial hemorrhage 2.Head injury/major surgery in past 3 months 3.Intracranial tumors/vascular abnormality/aneurysms 4.Active bleeding/bleeding disorders 5.Peptic ulcer 6.Any wound or recent fracture or tooth extraction 7.Severe Hypertension
- 14. ANTIFIBRINOLYTIC DRUGS These are drugs which blocks the conversion of plasminogen to plasmin & thus inhibit fibrinolytic activity. Egs:- Epsilon amino-caproic acid (EACA) Tranexamic acid.
- 16. Epsilon amino-caproic acid (EACA) Inhibits plasminogen to plasmin convertion, hence prevents clot lysis It is a specific antidote for fibrinolytic agents In haemophiliacs, it has adjunctive value for controlling bleeding due to tooth extraction, prostatectomy, trauma, etc.
- 17. Tranexamic acid It is 7 times more potent than EACA, more commonly used. Oral, i.v, topical administration In dentistry, tranexamic acid soaked guaze or mouthwash is used to reduce bleeding postoperatively in hemophiliacs and pts on anticoagulants
- 18. • Antidote for Fibrinolytic drugs. • In Cardio-pulmonary bypass surgery. • Tonsillectomy, prostatic surgery, tooth extraction • Menorrhagia • Recurrent epistaxis, peptic ulcer. USES OF ANTIFIBRINOLYTIC DRUGS