Fibrinolytic (FETT)

Blood products and modifiers

ALTEPLASE

Fibrinolytics promote the degradation of thrombi by activating plasminogen to plasmin.

• Fibrin-specific agents

  • Tissue plasminogen activator (tPA)

  • Recombinant plasminogen activators (rtPA): tPAs that are produced by recombinant biotechnology techniques

    • Alteplase

    • Reteplase (rPA)

    • Tenecteplase (TNK-tPA)

• Non-fibrin-specific agents

  • Streptokinase: enzyme produced by group A streptococci; catalyzes the conversion of plasminogen to plasmin

  • Urokinase: serine protease found in plasma, urine, and various types of tissue that is also used in fibrinolytic therapy

directly or indirectly increase the concentration of plasmin → cleavage of thrombin and fibrin

• ↑ PT

• ↑ PTT

• Normal platelet count

• Bleeding (e.g., intracranial hemorrhage)

• Hypersensitivity reactions (esp. to streptokinase)

• Early STEMI (< 12 hours)

• Early ischemic stroke (< 3 hours)

• Massive pulmonary embolism

• Active bleeding

• Prior intracranial hemorrhage

• Recent surgery

• Severe hypertension

• Known bleeding diathesis

• Antifibrinolytics: group of drugs that impair fibrinolysis, typically by interfering with plasmin formation

  • Tranexamic acid: a synthetic lysine analog and inhibitor of plasminogen with antifibrinolytic action

  • Aminocaproic acid: a lysine derivative and inhibitor of plasminogen activators and plasmin with antifibrinolytic action

• Fresh frozen plasma (FFP), PCC, or cryoprecipitate (Cryoprecipitate is obtained from frozen blood plasma via centrifuge and contains more factor VIII and fibrinogen than FFP.)

• Platelet transfusions (if necessary)