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BY :DR. ISRAA OMAR It is initiated concomitantly with coagulation cascade, resulting in the formation of active plasmin ,which digest fibrin . The main drug of this group are streptokinase and tissue plasminogen activator (tPA),for example alteplase The main use is in acute STMI ,acute stroke, clearing cannula ,arterial thromboembolism and life threatening DVT and pulmonary embolism Is a non –enzyme protein extracted from culture of streptococci It form stable complex with plasminogen and gains enzymic activity ;then causes fibrinolysis The major adverse effect is bleeding include GI Hemorrhage and stroke Hemorrhage can be treated with traneximic acid Hypotension and hypersensitivity may also recorded Both are recombinant tissue plasminogen activators. Alteplase is a single chain where as duteplase is a double chain They preferentially plasminogen that is bound to fibrin ,they are said to be clot selective . They dissolve formed thrombus and avoid systemic activation of plasminogen They can cause hemorrhage but less than streptokinase No hyper sensitivity reaction occur with them 1. 2. 3. 4. 5. 6. 7. Active internal bleeding Bleeding diatheses Pregnancy Uncontrolled hypertension CPR Recent major surgery or Eye surgery Recent hemorrhagic stroke BY:DR ISRAA OMAR Both are synthetic agents Work by inhibition of plasminogen activation They are orally active A potential side effect of treatment is intravascular thrombosis It stops bleeding by blocking plasmin It can inhibit streptokinase It is used to reduce blood loss in patients undergoing cardiopulmonary bypass surgery Side effect include anaphylactic reaction if there is previous exposure within 12 month , renal dysfunction is also reported with the use of this drug Antagonizes the anticoagulant effect of heparin It is derived from fish sperm and testes and has a high content of arginine which make it basic drug It is positive charge neutralize the negative charge of heparin thus making a stable complex and prevent the action of heparin Side effect include dyspnea , flushing , hypotension and bradycardia especially when injected rapidly It antagonize the action of oral anticoagulant The action of vitamin k start after 24 hours; thus ,if immediate action is required ,fresh frozen plasma should be infused Thank you