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Thrombolysis
Agents
- streptokinase
- half-life 80 mins
- derived from beta haemolytic streptococci
- anisteplase
- urokinase
- derived from fetal kdiney cells
- recombinant prourokinase
- Tissue Plasminogen Activator (rTPA, alteplase)
- vastly more expensive
- used if streptokinase given 5 days to 1 year previously or previous
allergic reaction to streptokinase
Indications
- Presentation within 12 hours or 12-24 hours with continuing pain and
evolving infarction on ECG
- Typical cardiac chest pain
- Either
- ST elevation
- >2mm in 2 or more chest leads
- >1 mm in 2 or more limb leads
- R waves and ST depression in V1-V3
- new onset bundle branch block
- Pulmonary embolism
- DVT
- systemic/local thrombosis
Contra-indications
Absolute
- Hypertension
- systolic >200
- diastolic >120
- stroke or active bleeding in last 2 months
- surgery in last 10 days
- proliferative diabetic retinopathy
- pregnancy
Relative
- prolonged / traumatic CPR
- General bleeding tendency
- warfarin
- haemophilia
- severe liver disease
- thrombocytopenia
- Local Bleeding Tendency
- recent surgery (<2 weeks)
- trauma
- eye bleeding
- peptic ulcer
- GI bleeding
- pregnancy
- serious PV bleed
- tooth extraction
- TB with cavitation
- Pre-existing thrombus (risk of embolus)
- endocarditis
- aortic aneurysm
Administration
- Give streptokinase 1.5 million units in 100mL 0.9% saline IVI over 1hour
- If the patient has previously reacted to SK or has received SK in the last
5 days-1 year Tissue plasminogen activator may be indicated.
- t-PA 1.5mg/kg over 3hr with heparin (e.g. 5000u bolus, then 1000u/h
IVI for 24hr, monitor activated partial thromboplastin time)
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