Thrombolytics and Procoagulants

by Pravin Shukle, MD

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    Thrombolytics are a different drug category that we use in coagulation cascades. Now, thrombolytics are different from anticoagulants in that they are active against clots that have already formed. So thrombolytics are a completely different class of drugs. They catalyze conversion of plasminogen to plasmin, and plasminogen to plasmin causes breakdown of fibrin. So the fibrin blood clot is actually broken down. It is used often in acute stroke after you've confirmed that there is no hemorrhage on the CT scan. We also use it in acute MI but that's more replaced by catheterization. Adverse events of course are bleeding and intracerebral hemorrhage. Now, I'm going to give you a clinical pearl that won't be useful on your exam but it's going to be useful in the real world. When you have a person who has an acute intracerebral hemorrhage, they will tell you somebody hit me in the back of the head with a baseball bat. They are so emphatic about how swiftly the headache came on and how severe it is that it's quite shocking. And I had a patient when I was a medical student who was put on a thrombolytic and they ended up developing an intracerebral hemorrhage. She told me it was as if somebody came and hit her on the back of the head. We were quick, we consulted neurosurgery, we put a Burr hole in, drilled a hole in her skull and took of the pressure and we preserved brain function and she lived. Had we not done that quickly within at least an hour of treating the patient that patient would have died. So, clinical pearl, intracerebral hemorrhage from these drugs, treat it very quickly with neurosurgery consult. Streptokinase is the prototypical drug and generally on exams we'll talk about streptokinase but...

    About the Lecture

    The lecture Thrombolytics and Procoagulants by Pravin Shukle, MD is from the course Pharmacology of Blood Coagulation. It contains the following chapters:

    • Thrombolytics
    • Procoagulants – Vitamin K
    • Procoagulants – Replacement Factors
    • Procoagulants – Vasopressin Agonists
    • Procoagulants – Antiplasmin Agents

    Included Quiz Questions

    1. tPA analogues show affinity for fibrin-bound plasminogen.
    2. tPA analogues decrease the time to onset of action.
    3. tPA analogues do not increase the risk for intracerebral hemorrhage.
    4. tPA analogues have a better safety profile.
    5. tPA analogues have a longer duration of activity.
    1. Head CT without contrast
    2. Head CT with contrast
    3. Platelet count
    4. PT/INR
    5. Cardiac biomarkers
    1. Requires hepatic activation.
    2. It is not very soluble in blood.
    3. It must be administered with a high fat meal.
    4. Requires low pH conditions for activation.
    5. It tends to pool at the injection site.
    1. Aminocaproic acid
    2. Idarucizumab
    3. Vitamin K
    4. Fresh frozen plasma
    5. Octaplex

    Author of lecture Thrombolytics and Procoagulants

     Pravin Shukle, MD

    Pravin Shukle, MD

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