Thrombolytics

Thrombolytics are medications that are used to break up blood clots. These medications have been used in the treatment of acute myocardial infarction but are primarily used for the treatment of acute ischemic stroke.  Contraindications include prior history of intracranial hemorrhage, recent ischemic stroke, brain tumor, and metastatic cancer.  

Class Drugs

• Alteplase (formerly tPA)

• Reteplase

• Tenecteplase

• Streptokinase

• Urokinase

Class Mechanism of Action

Converts plasminogen to plasmin

• Plasmin cleaves thrombi, resulting in lysis of thrombi

Mechanism of action of thrombolytic medications.

Class Applications

See individual drugs

Class Adverse Effects

Bleeding, can be life threatening

• Dissolves all clots, including beneficial clots

• Uncontrollable, life threatening hemorrhage may result

• No reversal agent

Contraindications

• History of intracranial bleeding

• Recent CVA

• Head trauma

• Brain tumor

• Metastatic cancer

Drug Table

Drug Name	Application	Comments	Image
Alteplase	Acute ischemic stroke; Acute MI; Used only when cardiac catheterization is not available in a timely fashion; Massive pulmonary embolism	Angioedema	"Alter" "Lace"
Reteplase	Acute MI; Used only when cardiac catheterization is not available in a timely fashion		"Retina" "First Place Trophy"
Tenecteplase	Acute ischemic stroke; Acute MI; Used only when cardiac catheterization is not available in a timely fashion		"Ten" "Tea Place"
Streptokinase	Rarely Used		"Strep" "Toe" "ACE Wrap"
Urokinase	Rarely Used		"Urinal" "ACE Wrap"