Embolis thrombolytics

Therapeutic uses Originally used for the treatment of deep-vein thrombosis and serious pulmonary embolism, thrombolytic drugs are now being used with increasing frequency to treat acute myocardial infarction and peripheral arterial thrombosis and emboli, and for unclotting catheters and shunts. 

Fibrinolytics (thrombolytics) can remove established thrombi and emboli. Inhibitors of the fibrinolytic system (antifibrinolytics) can be of value in certain haemorrhagic states notably those characterised by excessive fibrinolysis. 

Anticoagulants and thrombolytics, particularly warfarin, can systemically embolize cholesterol particles from aortic atherosclerotic plaques to small arteries and arterioles, including renal arterioles. These agents remove or prevent thrombus formation over ulcerative plaques, causing emboh. Cholesterol emboli induce an inflammatory obliterative vascular response, causing renal ischemia. Purple discoloration of the toes and mottled skin over the legs are important clinical clues. 

Urokinase, a thrombolytic enzyme (4400 lU/kg over 10 minutes followed by 4400 lU/kg hourly), is indicated for lysis of acute massive pulmonary emboli and of pulmonary... 

C. Clinical Use The major application of the thrombolytic agents is in the emergency treatment of coronary artery thrombosis. Under ideal conditions (ie, treatment within 1—4 hours), these agents may cause prompt recanalization of the occluded vessel. Very prompt use (ie, within 3 hours of the first symptoms) of t-PA in patients with ischemic stroke appears to result in a significantly better clinical outcome. Cerebral hemorrhage must be positively ruled out before such use. The thrombolytic agents are also used in cases of multiple pulmonary emboli. 

Early application of reperfusion therapy with thrombolytic agents has significantly improved the outcomes of acute myocardial infarction and other conditions, such as pulmonary embolism, DVT, arterial thrombosis, acute thrombosis of retinal vessel, extensive coronary emboli, and peripheral vascular thromboembolism (124). 

The nurse is administering alteplase (Activase), a thrombolytic, to a client diagnosed with massive pulmonary emboli (PE). Which data indicates the medication is effective ... 

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