fibrinolytics

1. By Dr. Md Yaqub

2. ⚫These are the drugs used to lyse thrombi/ clot to
recanalize occluded blood vessels (mainlycoronary
artery).
⚫Theyact by activating natural fibrinolyticsystem

3. 3

4. • The process of dissolution of clot is called
fibrinolysis
• Egs:- Streptokinase
• Urokinase
• Alteplase
• Reteplase
• Tenecteplase

6. Streptokinase
⚫ Obtained from -hemolyticstreptococci group C.
⚫ Binds with circulating plasminogen to form complex thatactivates
plasminogen toplasmin
⚫ Its non fibrin specific. i.e. activates bothcirculating as well as fibrin
bound plasminogen. Predisposes to bleeding
⚫ It is leastexpensive

7. ⚫ It is destroyed bycirculating antistreptococcal antibodies
⚫ Stk is antigenic- hypersensitivityreaction, anaphylaxis in 1-2%.
⚫ Adverseeffects:- Fever, hypotension, allergicreactions, arrhythmias
can occur.

8. Urokinase
human urine, human kidneycells.
Non antigenic, notdestroyed byantibodies.
Adverseeffects:-Hypotensionand allergicphenomenonare rare.
Fevercan 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 mayoccur
⚫Moreeffective, 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/majorsurgery in past 3 months
3.Intracranial tumors/vascularabnormality/aneurysms
4.Active bleeding/bleeding disorders
5.Pepticulcer
6.Anywound orrecent fractureor toothextraction
7.Severe Hypertension

14. ANTIFIBRINOLYTIC DRUGS
These are drugs which blocks the conversion of
plasminogen toplasmin & thus inhibit fibrinolytic
activity.
Egs:- Epsilon amino-caproic acid (EACA)
Tranexamic acid.

16. Epsilon amino-caproic acid (EACA)
⚫Inhibits plasminogen to plasmin convertion, hence
preventsclot lysis
⚫ It is a specific antidote forfibrinolyticagents
⚫ 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, morecommonly
used.
⚫Oral, i.v, topical administration
⚫In dentistry, tranexamic acid soaked guaze or
mouthwash is used toreduce bleeding postoperatively
in hemophiliacs and ptson anticoagulants

18. • Antidote for Fibrinolytic drugs.
• In Cardio-pulmonary bypass
surgery.
• Tonsillectomy, prostatic surgery,
tooth extraction
• Menorrhagia
• Recurrentepistaxis, peptic ulcer.
USES OF ANTIFIBRINOLYTIC DRUGS