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
4. • The process of dissolution of clot is called
fibrinolysis
• Egs:- Streptokinase
• Urokinase
• Alteplase
• Reteplase
• Tenecteplase
5.
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
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.
15.
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