Thrombolytics
In countries where patients do not have rapid access to catheterisation, streptokinase is still important - Peter Sleight
.jpg "Thrombolytics")
image by: Donna Adamchick
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Clot Busters - Discovery of Thrombolytic Therapy for Heart Attack and Stroke
What do the search for antibiotics in the 1930s, the discovery of the double helix in the 1950s, and an extremely aggressive case of melanoma skin cancer in the 1970s have in common? They all contributed a piece of the puzzle to a breakthrough treatment for heart attacks and the most common form of stroke.
That treatment, a class of “clot busting drugs” called thrombolytics, has saved untold lives. Yet as in so much of science, the introduction of thrombolytics took a long, circuitous route, with both head-scratching bewilderment and “aha!” moments along thway. The emerging, disparate pieces did not appear to belong to the same puzzle, much less to one pertaining to the heart or…
Resources
The rise and fall of the clot buster
The clot buster rivalry of the 1990s came to an abrupt end when studies showed that primary percutaneous coronary intervention (PCI) yielded better results than any of the pharmacological options.
Clot Busters May Benefit Tardy Heart Attack Patients
Although primary PCI has emerged as the best treatment for STEMI, most patients don't receive this treatment within the early time frame when it is known to be most beneficial. Delay in presentation is one important factor. Another is that most patients don't arrive at a PCI-capable hospital and cannot be transferred fast enough to a PCI hospital.
Thrombolytics Given for Major Heart Attack (STEMI)
Benefit was demonstrably greater with earlier treatment, with the most benefit apparent for treatment given within a few hours of symptom onset. Benefits were smaller and less statistically robust in the 12 to 24 hour period. Patients with ST-depressions were harmed rather than helped.
Fibrinolytic Checklist for STEMI*
Indications and Contraindications.
Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction
NICE has also made recommendations about which drugs to use where emergency care arrangements for people having a heart attack include giving thrombolytic drugs before the patient reaches hospital – for example, this might be the setup for communities a long way from a hospital with emergency facilities.
Thrombolysis in Myocardial Infarction
Since the early 1980s, thombolysis has been the cornerstone of treatment for patients having ST segment elevation myocardial infarctions (STEMI) by improving outcomes and preserving left ventricular function. There are in fact many large randomised clinical trials which support early thrombolysis and these can be found in the Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group publication from 1994.
Clot Busters - Discovery of Thrombolytic Therapy for Heart Attack and Stroke
The development of thrombolytics (“clot-busters”) to treat heart attack and stroke followed a complex pathway of basic research and clinical observation. Natural clot busting agents, from human blood vessels, leeches, vampire bat saliva, and bacteria all played a role in helping scientists understand how to harness the power of thrombolytics to save lives.
Activase
Activase (TPA) is indicated for use in the management of acute myocardial infarction in adults for the improvement of ventricular function following AMI, the reduction of the incidence of congestive heart failure, and the reduction of mortality associated with AMI. Treatment should be initiated as soon as possible after the onset of AMI symptoms.
Retavase
RETAVASE® (reteplase) is indicated for use in the management of acute myocardial infarction (AMI) in adults for the improvement of ventricular function following AMI, the reduction of the incidence of congestive heart failure, and the reduction of mortality associated with AMI. Treatment should be initiated as soon as possible after the onset of AMI symptoms.
Streptase
Streptokinase, is indicated for use in the management of acute myocardial infarction (AMI) in adults, for the lysis of intracoronary thrombi, the improvement of ventricular function, and the reduction of mortality associated with AMI, when administered by either the intravenous or the intracoronary route, as well as for the reduction of infarct size and congestive heart failure associated with AMI when administered by the intravenous route.
Urokinase
Urokinase is a man-made product developed using a protein that occurs naturally in the kidneys. Urokinase is a thrombolytic agent that works by dissolving blood clots.
Care Clinical Research
Bleeding is the major complication of thrombolytic therapy. Consequently, absolute contraindications include dissecting aortic aneurysm, pericarditis, stroke, or neurosurgical procedures within 6 months or known intracranial neoplasm. Relative contraindications include major surgery or bleeding within 6 weeks, known bleeding diathesis, and severe uncontrolled hypertension. •Allergic reactions: SK and anistreplase are potentially allerogenic. Patients are usually pretreated with intravenous hydrocortisone 100 mg. •Antibody production: SK and anistreplase induce antibody production, which makes retreatment with either of these agents less effective.
Drugs.com
Thrombolytic medication is used to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
FP Notebook
MI Thrombolysis.
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