Fibrinolytics & Antifibrinolytics: Pharmacology

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Video Summary:
Fibrinolytics are the drugs that dissolve clot. They all are given by intravenous route. Streptokinase is obtained from group C β haemolytic streptococci. It complexes with plasminogen and that plasminogen, activates other plasminogen. It is less fibrin specific as compared to all other drugs. It should not be used for 1 year after streptococcal infection or streptokinase use due to antibodies. It also causes hypersensitivity reaction like anaphylaxis. Because of all these disadvantages, it is rarely used now. However, it is very cheap. Urokinase is obtained from cultured human kidney cells. Alteplase is recombinant tissue plasminogen activator. Reteplase and tenecteplase are modified versions. They have longer half-life and can be given bonus. In circulation, they have less affinity for plasminogen, however in clot they bind with lysine residues on fibrin which increases activation of plasmin. Fibrinolytics are used in myocardial infarction, peripheral arterial thromboembolism, acute ischemic stroke, deep vein thrombosis and pulmonary embolism and to restoring catheter and shuts. They are more effective on venous thrombi than on arterial thrombi. And on recent thrombi than on older thrombi. Adverse event of fibrinolytics are bleeding due to dissolution of physiological clot and systemic lytic state, fever and hypotension. They are contraindicated in patients with history of intracranial bleeding, ischemic stroke in past 3 months, brain tumour or vascular abnormality, bleeding disorders, active bleeding, head trauma, peptic ulcer, oesophageal varices, recent internal bleeding, metastatic cancer, uncontrolled hypertension and pregnancy. Now antifibrinolytics. Drugs in this group are epsilon aminocaproic acid and tranexamic acid. They are lysine analogues. They bind with lysine binding sites of plasminogen and plasmin as well as tissue plasminogen activator. It prevents their binding with fibrin, so the fibrinolysis is prevented. They are used in haemophilia, bleeding from fibrinolytics, menorrhagia, recurrent epistaxis, hyphaemia, peptic ulcer, bleeding after postprostatectomy, tooth extraction or tonsillectomy and cardiopulmonary bypass surgery. Their adverse events are thrombosis, renal failure in patients of haematuria, gastrointestinal distress, myopathy and hypotension.

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DISCLAIMER: This video is for education purpose only. Although every effort is made to ensure accuracy of material, viewer should refer to the appropriate regulatory body/authorised websites, guidelines and other suitable sources of information as deemed relevant and applicable. In view of possibility of human error or changes in medical science, any person or organization involved in preparation of this work accepts no responsibility for any errors or omissions or results obtained from use of information in this video.