Thrombolytics
Physicians trained after the advent of thrombolytic therapy may find it difficult to believe that this concept was one of the most hotly debated pathophysiological tenets of the 20th century - Marie-Germaine Bousser
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 the way. The emerging, disparate pieces did not appear to belong to the same puzzle, much less to one pertaining to the heart or…
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Why we should be very wary of using clotbusting drugs to treat acute strokes
It took trials and studies on 60 000 heart attack patients to work out that clot busters prevent deaths in heart attacks, but that they only worked on one type of heart attack (which is only about 5% of all heart attacks). So we took the time to get it right, refining study after study, until we were sure that introducing a potentially dangerous drug had benefits that outweighed the harms. Every type of clot buster that was studied worked, and the earlier it was given, the better. Interestingly, the one that caused the most brain bleeding was tPA.
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.
Alteplase: The Clot Buster
Alteplase has a mechanism of action that makes it fibrin specific and thus favorable for thrombolytic therapy (Figure 5). First, alteplase attaches to fibrin on the surface of a clot and initiates fibrin bound plasminogen. Then plasmin is cleaved from the plasminogen associated with the fibrin, fibrin molecules are broken apart by the plasmin, and the clot dissolves.
The Safe and Appropriate Use of Thrombolytics in the Emergency Department
Thrombolytics are utilized regularly in emergency departments (EDs) for management of acute, life-threatening thromboses. Since there is a significant bleeding risk associated with therapy, patients must meet specific criteria for safe and effective use of these medications.1 Despite these criteria, inconsistencies in patient eligibility, dosing, and administration may be more common than realized.
Thrombolysis in the Developing World: Is There a Role for Streptokinase?
Streptokinase, a lower cost alternative thrombolytic agent, is widely available in developing countries where it is utilized to treat patients with acute coronary syndromes. Although this drug has previously been found to be ineffective in ischemic stroke, the lack of benefit may have been related to a number of factors related to trial design rather than the drug itself.
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.
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.
Alteplase (Activase)
It is a tissue plasminogen activator (tPA) It enhances the conversion of plasminogen to plasmin by binding to fibrin initiating fibrinolysis with limited systemic proteolysis. The circulating plasminogen that has been activated will cause a systemic lytic state Alteplase requires fibrin as a cofactor for the activation of plasminogen.
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.
Tenecteplase
The only lytic delivered as a 5-second IV bolus for the treatment of acute ST elevation myocardial infarction (STEMI), TNKase® (tenecteplase) enables you to intervene quickly.
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.
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