Thrombolytics are used to rapidly break down an existing clot when restoring blood flow is urgent. This lesson explains how they differ from anticoagulants and antiplatelet drugs, how they work, and the main uses and practical characteristics of alteplase and tenecteplase.
Anticoagulants and antiplatelet drugs mainly prevent clot formation or prevent an existing clot from worsening while the body gradually breaks it down. Thrombolytics, by contrast, act to break down an existing clot quickly. This rapid action may be important when a clot is obstructing blood flow to a major organ.
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What is the main action of a thrombolytic?
It rapidly promotes breakdown of an existing clot by facilitating conversion of plasminogen to plasmin, which initiates fibrinolysis.
What is fibrinolysis?
Fibrinolysis is the breakdown of fibrin in a clot. Plasmin is the enzyme that promotes this breakdown.
What are the major indications for alteplase?
Alteplase is used for acute ischemic stroke, acute myocardial infarction, and acute massive pulmonary embolism. A small catheter-directed dose can also restore function of a dysfunctional central venous access device.
What are key practical features of tenecteplase?
Tenecteplase is approved for STEMI and can be prepared relatively quickly and administered as a single IV bolus without a dedicated IV line or infusion pump. It may also be used off-label for acute ischemic stroke in some settings.
Why avoid calling alteplase “tPA”?
The shorthand can be confused with tenecteplase or total parenteral nutrition. Using the full drug name helps reduce medication errors and treatment delays.
Quiz questions
Which adverse effect is the principal serious concern with thrombolytic therapy?Answer: Bleeding, which can be severe or fatal.
After thrombolysis restores coronary blood flow following acute myocardial infarction, which complication may occur?Answer: Dysrhythmias related to coronary reperfusion.
Which condition is an example of a bleeding-related contraindication to thrombolytic therapy?Answer: Active internal bleeding.
If arterial puncture is necessary during a thrombolytic infusion, what precaution is recommended?Answer: Use a compressible upper-extremity vessel, apply pressure for 30 minutes, and monitor the site.
What should a client receiving thrombolytic therapy do before scheduling an invasive procedure?Answer: Contact the health care provider for guidance.
Based on Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver (OpenStax), licensed CC BY 4.0. Adapted into a summary, flashcards and quizzes.