fibrinolytics and anti-fibrinolytics

1. By Dr. Md Yaqub

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

3. 3

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

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

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/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.

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