• Clinical Info

Uses

Coronary Artery Thrombosis and MI

Management of selected cases of acute evolving transmural MI, with heparin and/or platelet-aggregation inhibitors (e.g., aspirin) as adjunctive therapy. Lysis of coronary artery thrombi associated with acute evolving transmural MI. The resulting reperfusion can limit infarct size, improve ventricular function, and reduce the incidence of CHF and associated post-MI mortality. Greater benefit in patients with an anterior MI, left bundle branch block, a history of diabetes mellitus, prior MI, hypotension (SBP <100 mm Hg), or tachycardia (>100 bpm).

Clinical benefit diminishes as the time period from symptom onset to initiation of therapy increases. If possible, administer thrombolytic therapy within 30 minutes of hospital admission or first contact with the health-care system. Use of alteplase or tenecteplase rather than streptokinase recommended by the American College of Chest Physicians (ACCP) in patients with AMI who can be treated within 6 hours of symptom onset. Delayed therapy (e.g., initiated within 7–24 hours) may benefit patients with persisting ischemic pain and ST-segment elevation or left bundle branch block. Not routinely recommended for patients presenting 12–24 hours after onset of MI symptoms. Primary PCI favored over thrombolytic therapy if onset of symptoms of AMI is greater than 3 hours or in patients with severe CHF and/or pulmonary edema (Killip class 3) with AMI symptoms present for 12 hours or less. Clinical judgment must guide appropriate patient selection.

May be preferred in patients who recently (e.g., within 6 months) have received streptokinase and require further thrombolytic treatment or who have had a streptococcal infection. ACCP, ACC, and AHA suggest avoidance of repeat administration of streptokinase.

Preferred in patients with a known allergy or hypersensitivity to streptokinase.

May be preferred in patients in whom hypotensive effects of streptokinase should be avoided.

Thrombolytic therapy may be reasonable in patients with true posterior MI presenting within 12 hours after onset of symptoms, provided no contraindications exist.

Has been used for prevention or reduction of reocclusion of the infarct-related coronary artery after thrombolysis.†

Pulmonary Embolism

Lysis of acute pulmonary emboli involving obstruction of blood flow to a lobe or multiple segments of the lungs. Lysis of acute pulmonary emboli accompanied by unstable hemodynamics (i.e., when BP cannot be maintained without supportive measures). Generally reserve IV thrombolytic therapy for those with acute massive pulmonary embolism accompanied by unstable hemodynamics who are not at risk for hemorrhage.

Acute Ischemic Stroke

Management of acute ischemic stroke to improve neurologic recovery and reduce the incidence of disability. Should be initiated within 3 hours following the onset of symptoms of acute ischemic stroke and only after intracranial hemorrhage has been excluded by cranial computed tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage. Use of thrombolytic therapy not recommended by American Stroke Association (ASA) and other authorities in patients with major early ischemic changes on baseline CT scan (defined as clearly identifiable hypodensity involving more than one-third of the middle cerebral artery territory).

Arterial Thrombosis and Embolism

Intra-arterial thrombolytic therapy for lysis of arterial occlusions† in peripheral vessels and bypass grafts in patients with acute (<14 days old) thromboembolic arterial ischemia. Such patients should have a low risk for the development of myonecrosis and ischemic nerve damage in the affected extremity during therapy.†

Occluded IV Catheters

Restoration of patency to central venous catheters obstructed by a thrombus (assessed by the ability to withdraw blood). Consider causes of catheter dysfunction other than thrombus formation (e.g., catheter malposition, mechanical failure, constriction by a suture, lipid deposits, drug precipitates) before use.