Thrombolysis is used in myocardial infarction (heart attack), thromboembolic strokes, deep vein thrombosis and pulmonary embolism to clear a blocked artery and avoid permanent damage to the perfused tissue (e.g. myocardium, brain, leg) and death. A less frequent use is to clear blocked catheters that are used in long-term medical therapy.
|Condition||Prothrombin time||Partial thromboplastin time||Bleeding time||Platelet count|
|Vitamin K deficiency or Warfarin||prolonged||prolonged||unaffected||unaffected|
|Disseminated intravascular coagulation||prolonged||prolonged||prolonged||decreased|
|Von Willebrand disease||unaffected||prolonged||prolonged||unaffected|
|Early Liver failure||prolonged||unaffected||unaffected||unaffected|
|End-stage Liver failure||prolonged||prolonged||prolonged||decreased|
|Factor V deficiency||prolonged||prolonged||unaffected||unaffected|
|Factor X deficiency as seen in amyloid purpura||prolonged||prolonged||unaffected||unaffected|
The thrombolytic drugs include:
- tissue plasminogen activator - t-PA - alteplase (Activase)
- reteplase (Retavase)
- tenecteplase (TNKase)
- anistreplase (Eminase)
- streptokinase (Kabikinase, Streptase)
- urokinase (Abbokinase)
These drugs are most effective if administered immediately after it has been determined they are clinically appropriate. The advantage of administration is highest within the first sixty minutes, but may extend up to six hours after the start of symptoms.
Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. If a patient has had thrombolysis before, an allergy against the thrombolytic drug may have developed (especially after streptokinase). If the symptoms are mild, the infusion is stopped and the patient is commenced on an antihistamine before infusion is recommenced. Anaphylaxis generally requires immediate cessation of thrombolysis.
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