VSPM MADHRIBAI DESHMUKH INSTITUTE OF NURSING
EDUCATION NAGPUR
DRUG STUDY
ON
THROMBOLYTIC AGENT
SUBMITTED TO,
Mrs Lata sukhare
professor,
VSPM MDINE,
Nagpur
SUBMITTED BY,
Miss Namralata singh
M.sc nursing 2nd year
VSPM MDINE ,
Nagpur
SUBMITTED ON,
GENERAL OBJECTIVE :-
At the end of class all student will be able to gain in depth of
knowledge on thrombolytic agent and will apply this in their clinical area .
SPECIFIC OBJECTIVE :- At the end of the class student will be able to :-
1. Define the thrombolytic agent
2. Describe the mechanism of action.
3. Classify the types of thrombolytic agent
4. Explain the indication of thrombolytic agent
5. Discuss the contraindication of thrombolytic agent
6. explain the side effect of thrombolytic agent
7. discuss the drug interaction of thrombolytic agent
8. explain the nursing responsibility of thrombolytic agent
OUTLINE –
THROMBOLYTIC AGENT
1. Introduction
2. Mechanism of action
3. Types
4. Indication
5. Contraindication
6. Side effect
7. Drug interaction
8. Nursing responsibility
9. Conclusion
10. Summary
11. References
INTRODUCTION –
Thrombolytic agent are the drugs used to lyse ( break) thrombi / clot to recanalyze occluded
blood vessels ( mainly coronary artery disease ).
A drug that dissolve a clot (thrombus) and reopen an artery or vein. Thrombolytic agents may be
used to treat a heart attack, stroke, deep vein thrombosis (clot in a deep leg vein), pulmonary
embolism, and occlusion of a peripheral artery or indwelling catheter.
MECHANISM OF ACTION –
Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a cleaved
product called plasmin. Plasmin is a proteolytic enzyme that is capable of breaking cross-links
between fibrin molecules, which provide the structural integrity of blood clots.
TYPES –
Sr. no Fibrin specific Non fibrin specific
t-PA (tissue plasminogen Streptokinase
activator Alteplase
TNKase (tenecteplase) Urokinase
Reteplase
FIBRIN SPECIFIC –
t-PA (tissue plasminogen activator)- An enzyme that helps dissolve clots. It
is a serine protease (enzymes that cleave peptide bonds in proteins) found on endothelial cells,
TNKase (tenecteplase)- It is a natural protein in man. It preferentially activates
plasminogen bound to fibrin clot and thus avoids systemic activation of plasminogen,
fibrinogen depletion and bleeding are thus minimized.
It is prepared by recombinant DNA technology from human tissue culture. It is
effective as streptokinase but may be safer. It has a short t1/2 of 8 minute.
It specifically activates gel phase plasminogen already bound to fibrin, and has
little action on circulating plasminogen.
It is metabolized by the liver.
Dose :
50 mg vial with 50 ml solvent water.
It is given in the dose of 10 mg IV over 1-2 minute, followed by IV infusion of 50 mg,
over 1 hours. then 40 mg, over the next 2 hours. (total dose 100 mg over 3 hours).
Patient weighing less than 67 kg, should receive a total dose of 1.5 mg/kg. heparin 5000u
is given IV bolus prior to administration of rtPA.
For myocardial infraction :
15 mg IV bolus injection followed by 50 mg over 30 minute, then 35 mg over the next 1 hour.
For pulmonary embolism :
100 mg IV infused over 2 hours.
Adverse reaction :
It is nonantigenic but nausea, mild hypotension, and fever may occur.
NON FIBRIN SPECIFIC –
Streptokinase- it is obtained from β haemolytic streptococci group C. streptokinase is
antigenic. It is given by parenteral route and has a short plasma t1/2of 30-80 mint.
Indication- acute MI, pulmonary embolism, deep vein thrombosis, peripheral arteral
occlusion.
Drug doses-
For MI – 7.5-15 lac IU infused over 1 hrs
For deep vein thrombosis and pulmonary embolism-2.5lac U
Adverse reaction :
Streptokinase is antigenic can cause hypersensitivity reactions and anaphylaxis,
specially when used second time in a patient.
Also less effective due to neutralization by antibodies.
Fever is common
Hypotension and arrhythmia is reported
Urokinase - It is an enzyme isolated from human urine now we prepared from
cultured human kidney cells . it activate plasmosin directly . it is non antigenic.
Indication – Acute MI , pulmonary embolism, deep vein thrombosis, peripheral arterial
occlusion.
Dose :
2.5 lac, 5 lac, 10 lac IU per vial injection.
It is administered IV in an initial dose of 4400 units per kg in 10 minute. Followed by
continuous infusion of the same dose per hour for 12-24 hours.
For myocardial infraction :
2.5 lac IU IV over 10 min followed by 5 lac IU over next 600 IU/min for up to 2 hour.
For venous thrombosis pulmonary embolism :
4400 IU/kg over 10 minute IV followed by 4400 IU/kg/hr. for 12 hr.
Alteplase- It is a serine protease that assists fibrin in the conversion of plasminogen to
plasmin. In the systemic circulation, alteplase binds to fibrin in a thrombus and initiates
fibrinolysis.
INDICATION –
Acute myocardial infarction – It is the chief indication recanalization of thrombosed
coronary artery disease has been achieved in 50-90% cases.
Deep vain thrombosis- Specially in leg pelvis, shoulder etc. up to 60% cases treated
successfully. The main advantage is preservation of venous valve and may be a reduce
risk of pulmonary embolism .
Pulmonary embolism- Fibrinolytic therapy is indicated in large , life threatening
pulmonary embolism.
Peripheral arterial occlusion- It is indicated only when surgical thrombectomy is not
possible. Fibrinolytics have no role in chronic peripheral vascular disease.
CONTRAINDICATION-
Thrombolytics therapy is contraindicate in all situation where the risk of bleeding
is increased-
Recent trauma
Surgery
Biopsies
Severe hypertension
Aneurysms ,diabetes
Acute pancreatitis.
SIDE EFFECT :-
Serious adverse reactions include GI, GU, intracranial and retroperitoneal bleeding and anaphylaxis. The
most common side effect are decreased Hct (haematocrit), urticarial, headache, hypotension and nausea.
PHARMACOKINETICS :-
Onset, peak, and duration very widely among products. Most products are metabolized in the liver and
excreted in urine.
DRUG INTERACTION :-
Interaction very widely among products. Check individual monographs for specific information.
NURSING CONSIDERATION:-
Nursing assessment :
Monitor BP, pulse rate, respiration, neurologic signs, temperature at least q 4 hr. (increased
temperature is an indicator of internal bleeding).
Assess for neurologic changes that may indicate intracranial bleeding.
Assess retroperitoneal bleeding, back pain, leg weakness, diminished pulse.
Assess for allergy, fever, rash, itching, chills, mild reaction may be treated with antihistamines.
Assess for bleeding during 1st hours of treatment, haematuria, hematemesis, bleeding from
mucous membrane, epistaxis and ecchymosis.
Monitor blood test Hct, platelet, PTT, PT, APTT before starting therapy. PT or APTT must be
less than 2 times control before starting therapy.
Patient or family education :
Teach patient to avoid venous or arterial puncture, injection, rectal temperature
Teach patient to treat fever with acetaminophen or aspirin.
Teach patient to apply pressure for 30 second to minor bleeding sites, inform prescriber if this
does not attain haemostasis, apply pressure dressing.
SUMMARY :
Today we have deals with the thrombolytic agents, in that introduction of thrombolytic
agents, definition of thrombolytic agents, types of thrombolytic agents in detail, contraindication,
adverse effect, precaution, pharmacokinetics, doses of thrombolytic agents, and nursing
responsibility.
REFERENCE :
1. “Mosby’s”, drug guide for nursing students, thirteenth edition, Elsevier publication,
volume 1, page no. 569-71
2. “KD Tripathi”, essential of medical pharmacology, 5 th edition, volume 1, jaypee
publication, page no. 480-483.
3. “R. S. Satoskar, S. D. Bhandarkar”, pharmacology and pharmacotherapeutics, revised
nineteenth edition, Elsevier publication, page no. 187.
