Thrombolytic drugs

Consequently, thrombolytic agents are administered whenever possible during the first few hours after 

Finally, thrombolytic drugs are gaining acceptance in treating other types of arterial and venous occlusion. For example, thrombolytic therapy can help dissolve clots in peripheral arteries (femoral, popliteal, and so forth)56 these drugs can help resolve thrombus formation in the large veins (DVT).68 This treatment 

Tissue plasminogen activator has been used successfully to treat acute myocardial infarction, and the benefits of this treatment are well documented.102,116 This drug, however, does not seem to be superior to other thrombolytics when treating coronary artery thrombosis, and streptokinase may be a more cost-effective method of treating myocardial infarction. Alternatively, t-PA may be more effective than other thrombolytics in its ability to initially reopen cerebral vessels this drug is often used preferentially during ischemic stroke.4,44 Hence, the added cost of t-PA may be justified in this situation. 

Reteplase (Retavase) and tenecteplase (TNKase) are newer thrombolytics. These agents are derived of human tissue plasminogen activator, and therefore 

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Discuss the uses, general drug actions, adverse reactions, contraindications, precautions, and interactions of warfarin, heparin preparations, and the thrombolytic drugs. 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking an anticoagulant or thrombolytic drug. 

Discuss ways to promote an optimal response to therapy, how to manage common adverse reactions, and important points to keep in mind when educating patients about the use of an anticoagulant or thrombolytic drug. 

Tenecteplase (TNKase) is the first thrombolytic drug that can be administered during a period of 5 seconds in a single dose The drug is administered intravenously only and offers the fastest administration of a thrombolytic in the treatment of an acute MI. Specific instructions for reconstitution come with the drug. The drug is reconstituted immediately before use because it contains no antibacterial preservatives. 

Heparin may be given along with and/or after administration with a thrombolytic drug to prevent another thrombus from forming. However, administration of an anticoagulant increases the risk for bleeding. The patient must be monitored closely for internal and external bleeding. 

Explains the need for continuous monitoring before and after administration of the thrombolytic drug. 

Combination GP Ilb/IIIa and rt-PA Therapy for Acute Stroke The combination of antiplatelet and thrombolytic drugs has proven efficacy in the setting of myocardial ischemia where an additive effect is seen. In acute stroke thrombolysis with a very narrow time window and less than 50% optimal reperfusion rates,adjunctive therapy with antiplatelets may be a promising approach. However, MAST-I concluded that the group of patients receiving streptokinase plus aspirin had a marked increase in 10-day mortality. 

Verstraete, M. 2000. Third generation thrombolytic drugs. American Journal of Medicine 109(1), 52-58. 

The hbrinolytic system (Fig. 22.2) is involved in restricting clot propagation in the blood and in the removal of fibrin as wounds heal. Treatment of patients with hbrinolytic (thrombolytic) drugs that activate the hbrinolytic system is not a substitute for the anticoagulant drugs. The purpose of thrombolytic therapy is rapid lysis of already formed clots. 

Thrombolytic drugs cause lysis of formed clots in both arteries and veins and reestablish tissue perfusion. 

Thrombolytic drugs are plasminogen activators. The ideal thrombolytic agent is one that can be administered... 

The contraindications to the use of thrombolytic drugs are similar to those for the anticoagulant drugs. Absolute contraindications include active bleeding, cardiopulmonary resuscitation (trauma to thorax is possible), intracranial trauma, vascular disease, and cancer. Relative contraindications include uncontrolled hypertension, earlier central nervous system surgery, and any known bleeding risk. 

The thrombolytic drug reteplase is improved over older drugs like streptokinase in what respect ... 

C. Reteplase binds to fibrin to cause a selective activation of fibrin-bound plasminogen. All fibrinolytic drugs are administered IV. Streptokinase is antigenic, whereas reteplase is not. Thrombocytopenia is not normally caused by thrombolytic drugs. 

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