Thrombolytics

1. FIBRINOLYTICS
(Thrombolytics)
S. Parasuraman, M.Pharm., Ph.D.,
Associate Professor,
Faculty of Pharmacy, AIMST University

2. Thrombolytics
• These are drugs used to lyse thrombi/clot to
recanalize occluded blood vessels (mainly coronary
artery). They are therapeutic rather than prophylactic
and work by activating the natural fibrinolytic system.

3. Thrombolytics
Streptokinase, Urokinase, Alteplase (rt-PA), Reteplase
Tenecteplase:
• Streptokinase is a protein synthesized by Streptococci that
combines with the proactivator plasminogen.
• Urokinase is a human enzyme synthesized by the kidney
that directly converts plasminogen to active plasmin.
• Alteplase is recombinant tissue plasminogen activator (rt-
PA). Risk of bleeding (0.5–5%) is the most important
concern.
• Reteplase is produced by recombinant technology and less
selective for fibrin bound plasminogen.
• Tenecteplase is a genetically engineered substitution mutant
of native t-plasminogen activator has higher fibrin selectivity.

4. Thrombolytics
Streptokinase, Urokinase, Alteplase (rt-PA), Reteplase
Tenecteplase:
• Uses of fibrinolytics:
• Acute myocardial infarction: The chief indication for
fibrinolytic therapy is ST-Elevation Myocardial
Infarction (STEMI).
• Deep vein thrombosis (DVT) in leg, pelvis, shoulder
etc.; up to 60% patients of DVT can be successfully
treated by fibrinolytics.
• Pulmonary embolism (PE) Fibrinolytic therapy is
indicated in large, life-threatening PE.

5. Thrombolytics
Streptokinase, Urokinase, Alteplase (rt-PA), Reteplase
Tenecteplase:
• Uses of fibrinolytics:
• Stroke: Thrombolytic therapy of ischaemic stroke is
dependent on time-lapse since symptom onset;
earlier, the better.
• Peripheral arterial occlusion: Indicated only when
surgical thrombectomy is not possible

6. Thrombolytics
• Administration of fibrinolytic drugs by the i.v. route is
indicated in cases of pulmonary embolism with
hemodynamic instability, severe deep venous
thrombosis such as the superior vena caval syndrome,
and ascending thrombophlebitis of the iliofemoral vein
with severe lower extremity edema.
• These drugs are also given intra-arterially, especially for
peripheral vascular disease.
Thank you