Thrombolytic enzmes include- Alteplase, Anistreptase, Streptokinas, Urokinase

Refer - Streptokinase

Reduced thrombolytic effect when given again some time later due to development of antibodies. Platelet inhibiotors like aspirin and indomethicin can potentiate the action of uronikase nad cause hemorrhage. Heparin and oral anticoagulant may increase risak of bleeding

Peripheral arterial thromboembolism

Thrombolytic enzmes include- Alteplase, Anistreptase, Streptokinas, Urokinase

Refer - Streptokinase

Bleeding, pyrexia, haematuria, thromboembolic episodes, hypersenstivity reactions. Severe bleeding anaphylaxis Thrombolytic enzymes

Bleeding- two types- Minor- ( superficial or surface bleeding) and Major -( internal, sdevee bleeding Incidence ) 0% to 16% .

The overal incidence of major bleeding with high IV dose infusion is 1.2 %

Allergic reactions- Urokinase- Is a protein origin , there is no evidence of induced antibody formation. relatively mild reactions (eg. bronchospasm, and skin rash ) are reported rarely and usally respond to conventional therapy

Streptokinase- Minor breathing difficulty , bronchospasm, periorbital swelling, angioneurotic edema, urticaria,itching, flushing, nausea, headache, musculoskeletal pain, and delayed hypersenstivity reactions, (eg. vasculitis, and interstilial nephritis)

Fever - Urokinase ( 2% to 3% ) a cause and effect relationship has not been established streptokinase ( 0% to 28% ) ocurs in patients treated intravenously with streptokinase Symptomatic treatment is usually sufficient Use acetoaminophen rather than aspirin

Guillian -Barre syndrome- Although a cause and effect relationship has not been established several reports suggests that streptokinase induces immunological response that may initiate this syndrome

Active internal bleeding, history of cerebrovascular accident, recent ( within 2 mths ) trauma of any kind including surgery, aneurism, known bleeding diathesis, severe unconcontrolled hypertension, Recent history of peptic ulcer disease, oesophageal varices, ulcerative colitis or other bleeding GI Iesions, pancreatis, subacute bacterial erndocarditis, coagulation defects including those due to Liver or kidney disease, or other recent surgery, childbirth or trauma, increased risk of cerebral bleedding eg. recent stroke or cerebral neoplasm.

Pregnancy

Special precautions-

Any vascular punctures or invasive procedures should be avoided as far as possible during or immediately before and after urokinase therapy and if unaviodable done with great care.

External chest compression. Caution in condition eg. possibility of left heart thrombus, subacute bacterial endocarditis, coagulation defects, cerbrovascular disease, diabetic retinopathy, and conditions in which bleeding could be dangerous.

Monitor for repurfusion arrthymias when usedd in MI.

Peripheral arterial thromboembolism

Dosage-

Adult- as soln contg 2000units/ml infuse into the clot via a catheter at a a rate of 4000 units /minute for 2 hour.

Monitor response using angiography. If clot is not removed advance catheter into occluded vessel and continue infusion at the same rate for another 2 hr. May repeat procedure , if needed up to 4 times.

Once blood flow is restabilshed partially withdraw the catheter and continue infusion at 1000units/minute until the remaining clot has lysed

Deep vein thrombosis- Adult- initially 4000 units/kg dissolved in 15ml Na Cl 0.9% infused over 10 minutes followed by 4400 units kg/hr for 12- 24 hr.