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Presented by
SREYA S
1st Semester M Pharm
Dept. of pharmacology
 Fibrinolytic drug, also called thrombolytic drug, any
agent that is capable of stimulating the dissolution of a
blood clot (thrombus)
 Fibrinolytic drugs work by activating the so-called
fibrinolytic pathway.
 Blood clots can occur in any vascular bed; however, when
they occur in coronary, cerebral or pulmonary vessels, they
can be immediately life-threatening
 coronary thrombi are the cause of myocardial infarctions,
cerebrovascular thrombi produce strokes, and pulmonary
thrombo emboli can lead to respiratory and cardiac failure.
 Therefore, it is important to rapidly diagnose and treat
blood clots.
 Thrombolytic drugs
dissolve blood clots by
activating plasminogen,
which forms a cleaved
product called plasmin.
Plasmin is a proteolytic
enzyme that is capable of
breaking cross-links
between fibrin
molecules, which provide
the structural integrity of
blood clots
 Tissue plasminogen activator (tPA)
Alteplase, Retaplase, Tenecteplase
 streptokinase (SK)
Streptokinase and anistreplase
 urokinase (UK).
This family of thrombolytic drugs is used in acute
myocardial infarction, cerebrovascular thrombotic stroke
and pulmonary embolism
 Alteplase is a recombinant form of human tPA.Moderately
specific for fibrin bound plasminigen. It has a short half-life
(~5 min) and therefore is usually administered as slow iv
infusion .non antigenic .
dis-Nausea ,mild hypotension
 Retaplase is a genetically engineered, smaller derivative of
recombinant tPA . Longer acting than rtPA. It is usually
administered as IV bolus injections. but less specific for
fibrin bound plasminogen. It is used for acute myocardial
infarction and pulmonary embolism.
 Dose- 10mg over 10min repeated after 30 min
 Tenecteplase (TNK-tPA) has a longer half-life and
greater binding affinity for fibrin than rtPA.
 Because of its longer half-life, it can be administered
by IV bolus Single bolus dose 0.5 mg/kg sufficient .
 Very expensive .
 It is only approved for use in acute myocardial
infarction STEMI
 Cranial bleeding
 Streptokinase and anistreplase are used in acute
myocardial infarction, arterial and venous thrombosis,
and pulmonary embolism. These compounds are
antigenic because they are derived from streptococci
bacteria.
 Natural streptokinase (SK) is isolated and purified from
streptococci bacteria. Its lack of fibrin specificity
makes it a less desirable thrombolytic drug than tPA
compounds because it produces more fibrinogenolysis.
 Anistreplase (Eminase®) is a complex of SK and
plasminogen. It has more fibrin specificity and has a
longer activity than natural SK; however, it causes
considerable fibrinogenolysis.
 Combines with circulating plasminogen forms
activator complex proteolysis of plasminogen
Active plasmin
• Cheap,widely used in India
Disadvantages
1 Activates both circulating & fibrin bound
plasminogen Depletion of circulating plasminogen →
bleeding
2. Antistreptococcal Abs from past infections inactivate
considerable fraction of initial dose , loading dose
needed
3 Repeat doses less effective due to neutralisation by
Abs
Uses
Acute myocardial infarction – 7.5 to 15 IU; I.V over 1
hr period • Deep vein thrombosis , Pulmonary
embolism
Adverse effects
Bleeding, hypotension, allergic reactions, fever,
arrhythmias
Contraindications
Recent trauma, surgery, abortion, stroke, severe
hypertension, peptic ulcer, bleeding disorders
 Urokinase, a protease enzyme that activates
plasminogen directly, is obtained from tissue
culture of human kidney cells
 It has limited clinical use because, like SK, it produces
considerable fibrinogenolysis; however, it is used for
pulmonary embolism.
 One benefit over SK is that UK is non-antigenic;
however, this is offset by a much greater cost
 Rapid acting, more potent
 Superior in dissolving old clots
 Short half life 4-8 min
 Nausea, mild hypotension, fever may occur.
 For MI : 2.2IU+-
 Acute myocardial infarction
 Deep vein thrombosis
 Pulmonary embolism
 Peripheral arterial occlusion
 Ischemic Stroke
 Intracranial hemorrhage.
 Head injury/major surgery in past 3 months
 Intracranial tumors/vascular abnormality/aneurysms
 Active bleeding/bleeding disorders
 Peptic ulcer
 Any wound or recent fracture or tooth extraction
 Severe Hypertension
 Antifibrinolytics are a class of medicationthat are inhibitors
of fibrinolysis.

 Aminocaproic acid
 Tranexamic acid.
 These lysine-like drugs interfere with the formation of the
fibrinolytic enzyme plasmin from its precursor plasminogen by
plasminogen activators (primarily t-PA and u-PA) which takes
place mainly in lysine rich areas on the surface of fibrin
.
 These drugs block the binding sites of the enzymes
or plasminogen respectively and thus stop plasmin formation.
 They are used in menorrhagia and bleeding tendency due to
various causes
Fibrinolytics

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Fibrinolytics

  • 1. Presented by SREYA S 1st Semester M Pharm Dept. of pharmacology
  • 2.  Fibrinolytic drug, also called thrombolytic drug, any agent that is capable of stimulating the dissolution of a blood clot (thrombus)  Fibrinolytic drugs work by activating the so-called fibrinolytic pathway.  Blood clots can occur in any vascular bed; however, when they occur in coronary, cerebral or pulmonary vessels, they can be immediately life-threatening  coronary thrombi are the cause of myocardial infarctions, cerebrovascular thrombi produce strokes, and pulmonary thrombo emboli can lead to respiratory and cardiac failure.  Therefore, it is important to rapidly diagnose and treat blood clots.
  • 3.
  • 4.  Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a cleaved product called plasmin. Plasmin is a proteolytic enzyme that is capable of breaking cross-links between fibrin molecules, which provide the structural integrity of blood clots
  • 5.  Tissue plasminogen activator (tPA) Alteplase, Retaplase, Tenecteplase  streptokinase (SK) Streptokinase and anistreplase  urokinase (UK).
  • 6. This family of thrombolytic drugs is used in acute myocardial infarction, cerebrovascular thrombotic stroke and pulmonary embolism  Alteplase is a recombinant form of human tPA.Moderately specific for fibrin bound plasminigen. It has a short half-life (~5 min) and therefore is usually administered as slow iv infusion .non antigenic . dis-Nausea ,mild hypotension  Retaplase is a genetically engineered, smaller derivative of recombinant tPA . Longer acting than rtPA. It is usually administered as IV bolus injections. but less specific for fibrin bound plasminogen. It is used for acute myocardial infarction and pulmonary embolism.  Dose- 10mg over 10min repeated after 30 min
  • 7.  Tenecteplase (TNK-tPA) has a longer half-life and greater binding affinity for fibrin than rtPA.  Because of its longer half-life, it can be administered by IV bolus Single bolus dose 0.5 mg/kg sufficient .  Very expensive .  It is only approved for use in acute myocardial infarction STEMI  Cranial bleeding
  • 8.  Streptokinase and anistreplase are used in acute myocardial infarction, arterial and venous thrombosis, and pulmonary embolism. These compounds are antigenic because they are derived from streptococci bacteria.  Natural streptokinase (SK) is isolated and purified from streptococci bacteria. Its lack of fibrin specificity makes it a less desirable thrombolytic drug than tPA compounds because it produces more fibrinogenolysis.  Anistreplase (Eminase®) is a complex of SK and plasminogen. It has more fibrin specificity and has a longer activity than natural SK; however, it causes considerable fibrinogenolysis.
  • 9.  Combines with circulating plasminogen forms activator complex proteolysis of plasminogen Active plasmin • Cheap,widely used in India Disadvantages 1 Activates both circulating & fibrin bound plasminogen Depletion of circulating plasminogen → bleeding 2. Antistreptococcal Abs from past infections inactivate considerable fraction of initial dose , loading dose needed 3 Repeat doses less effective due to neutralisation by Abs
  • 10. Uses Acute myocardial infarction – 7.5 to 15 IU; I.V over 1 hr period • Deep vein thrombosis , Pulmonary embolism Adverse effects Bleeding, hypotension, allergic reactions, fever, arrhythmias Contraindications Recent trauma, surgery, abortion, stroke, severe hypertension, peptic ulcer, bleeding disorders
  • 11.  Urokinase, a protease enzyme that activates plasminogen directly, is obtained from tissue culture of human kidney cells  It has limited clinical use because, like SK, it produces considerable fibrinogenolysis; however, it is used for pulmonary embolism.  One benefit over SK is that UK is non-antigenic; however, this is offset by a much greater cost
  • 12.  Rapid acting, more potent  Superior in dissolving old clots  Short half life 4-8 min  Nausea, mild hypotension, fever may occur.  For MI : 2.2IU+-
  • 13.  Acute myocardial infarction  Deep vein thrombosis  Pulmonary embolism  Peripheral arterial occlusion  Ischemic Stroke
  • 14.  Intracranial hemorrhage.  Head injury/major surgery in past 3 months  Intracranial tumors/vascular abnormality/aneurysms  Active bleeding/bleeding disorders  Peptic ulcer  Any wound or recent fracture or tooth extraction  Severe Hypertension
  • 15.  Antifibrinolytics are a class of medicationthat are inhibitors of fibrinolysis.   Aminocaproic acid  Tranexamic acid.  These lysine-like drugs interfere with the formation of the fibrinolytic enzyme plasmin from its precursor plasminogen by plasminogen activators (primarily t-PA and u-PA) which takes place mainly in lysine rich areas on the surface of fibrin .  These drugs block the binding sites of the enzymes or plasminogen respectively and thus stop plasmin formation.  They are used in menorrhagia and bleeding tendency due to various causes