Thrombolytics (Last Updated - 4/11/2005)

1) t-PA (Tissue Plasminogen Activator)
2) Alteplase (Activase)
3) Anistreplase (Eminase)
4) Prourokinase (Saruplase) --> not FDA-approved
5) Reteplase (Retavase)
6) Streptokinase (Streptase) --> DOC
7) Urokinase (Abbokinase)

-Hemorrhagic Toxicity Of Thrombolytics:
     A) Fibrin (Ia) lysis @ physiological thrombi --> sites of actual true vascular injury
     B) Systemic Lytic State:
          -Increased plasmin formation & increased digestion of Factors V & VIII

     -w/ out heparin --> < 1% risk of serious hemorrhage

-Why Not Use Thrombolytics For Venous Thromboses or a PE?:
     -b/c both require 12-72 hrs. of tx.
          -very high risk of bleeding w/ long-term thrombolytics (vs. just 1-3 hrs. for an Acute MI)