Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| converts Prothrombin (Factor II) into Thrombin (Factor IIa) |
|
Definition
|
|
Term
| mediates conversion of fibrinogen to fibrin |
|
Definition
|
|
Term
| helps form a crosslinked fibrin clot |
|
Definition
|
|
Term
| dissolution of fibrin by action of plasmin |
|
Definition
| Fibrinolysis (Thrombolysis) |
|
|
Term
| Regulatory mechanism for maintaining blood flow |
|
Definition
| removes fibrin deposits; prevents formation of unnecessary fibrin clots |
|
|
Term
| primary compounds of the fibrinolytic system |
|
Definition
|
|
Term
| Fibrinolysis is initiated |
|
Definition
| by activation of plasminogen --> plasmin which degrades the clot |
|
|
Term
| endogenous tissue plasminogen activators are released in response to |
|
Definition
| thrombin, venous stasis, physical exercise, ischemia |
|
|
Term
|
Definition
| enzymatically digests fibrin, dissolves the clot, releases fibrin degradation products, activity only happens at the site of the clot |
|
|
Term
| Moderators of fibrinolysis |
|
Definition
| plasminogen activator inhibitor type I (PAI-1), Antiplasmin |
|
|
Term
| Initiates local fibrinolysis by binding to fibrin in a thrombus and converts entrapped plasminogen to plasmin |
|
Definition
|
|
Term
| Fibrin specific agent; first recombinant tissue-type plasminogen activator and is identical to native tPA |
|
Definition
|
|
Term
| fibrin specific agent; second-generation recombinant tissue-type plasminogen activator that seem to work more rapidly and to have a lower bleeding risk than the first generation agent |
|
Definition
|
|
Term
| third generation thrombolytic agent approved for use in clinical practice; genetically engineered, multiple point mutant of t-PA |
|
Definition
|
|
Term
| Tenecteplase (TNK)- highest fibrin specific thus far |
|
Definition
| decreased bleeding side effects |
|
|
Term
| NOT FDA approved, non-specific (serine protease); single chain polypeptide derived from beta-hemolytic streptococcus cultures |
|
Definition
|
|
Term
| only FDA approved for acute PE; non-specific (serine protease); major activator of fibrinolysis in the extravascular compartment |
|
Definition
|
|
Term
| STE ACS within 12 hours of onset of chest discomort with at least 1 mm of STE in two or more contiguous ECG leads or new left bundle-branch block |
|
Definition
| Fibrinolytic Indications and Parameters for STEMI |
|
|
Term
|
Definition
| Time of onset --> Door --> Data --> Decision --> Drug (goal is to implement within 30 minutes) |
|
|
Term
| CHEST recommendations for Fibrinolytic use |
|
Definition
| For STEMI with symptom duration <12 hours for whom PCI cannot be performed; for STEMI with symptoms duration <6 hrs alteplase or tenectoplase and suggest reteplase over streptokinase (removed from the market) |
|
|
Term
| Fibrinolytic therapy absolute contraindications |
|
Definition
| any prior intracranial hemorrhage, known cerebral vascular lesions, known malignant intracranial neoplasm, ischemic stroke within 3 months (except acute ischemic stroke within 3 hrs), suspected aortic dissection; active bleeding or bleeding diathesis, significant closed head or facial trauma within 3 months |
|
|
Term
| Fibrinolytic therapy relative contraindications |
|
Definition
| hx of chronic, severe or poorly controlled HTN, hx of prior ischemic stroke > 3 mo, dementia, or known intracranial pathology not covered in absolute CI; traumatic or prolonged CPR or major surgery within 3 weeks; recent internal bleeding; pregnancy; active peptic ulcer; current use of anticoagulants |
|
|
Term
|
Definition
| results of trials argue against use of IV therapy, ACC/AHA guidelines on management recommends against the use of fibrinolytics |
|
|
Term
| fibrinolytic indications and parameters for acute ischemic stroke |
|
Definition
| the sooner IV r-tPA is initiated the more likely benefit will be seen; txt should be initiated w/in 3 hrs of symptom onset |
|
|
Term
| prior to r-tPA administrated for Acute Ischemic stroke all these requirements must be confirmed |
|
Definition
| txt commenced within the required 4.5 hr window; persistent measurable neurlogic deficit; noncontract head CT or brain MRI is without hemorrhage; blood pressure parameters are met; 2 IV lines are in place; accurate body weight has been determined |
|
|
Term
| patients who could be treated with r-tPA |
|
Definition
| diagnosis of ischemic stroke causing measurable neurologic deficit; onset of symptoms within 3 hrs of symptom onset; age greater than nor equal to 18 years |
|
|
Term
| absolute exclusion criteria for r-tPA therapy |
|
Definition
| head trauma or prior stroke in last 3 months, symptoms suggesting subarachnoid hemorrhage; arterial puncture at noncompressible site in previous 7 days; history of previous intracranial hemorrhage; elevated blood pressure; acute bleeding diathesis (platelet count <100,000, heparin received w/n 48 hrs resulting in aPTT >upper limit of normal), current use of anticoagulante with INR > 1.7 or PT >15sec; blood glucose <50 mg/dL; CT demonstrates multilobar infarction |
|
|
Term
| relative exclusion criteria for r-tPA therapy |
|
Definition
| only minor or rapidly improving stroke symptoms; seizure at onset with postictal residual neurologic impairments; major surgery or serious trauma within previous 14 days; recent GI or urinary tract hemorrhage w.in previous 21 days; recent acute MI w/in previous 3 months |
|
|
Term
| Fibrinolytic agent of choice in acute ischemic stroke |
|
Definition
| Alteplase (0.9 mg/kg total dose) |
|
|
Term
| Fibrinolytic indications for VTE |
|
Definition
| presence of hypotension related to PE; presence of severe hypoxemia; substantial perfusion defect; right ventricular dysfunction associated with PE; extensive DVT |
|
|
Term
| advantages of fibrinolytic therapy in PE |
|
Definition
| improves arterial blood pressure; improve right ventricular function; improves pulmonary perfusion in the short-term |
|
|
Term
| fibrinolytic therapy in DVT |
|
Definition
| seldom used; associated with more rapid and complete lysis; less postthrombotic syndrome; increased risk of bleeding outweighs benefit of fibrinolysis--- Only one widely accepted indication for lower extremity DVT (associated with severe symptomatic swelling or limb-threatening ischemia) |
|
|
Term
| bleeding complications: sites that don't require discontinuation of r-tPA |
|
Definition
| oozing from IV catheter sites; ecchymoses; gum bleeding |
|
|
Term
| bleeding complications: sites that may require discontinuation of r-tPA |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| acute ischemic stroke agent of choice |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| seldom used: alteplase when used |
|
|
Term
| major complication of fibrinolytic therapy |
|
Definition
| bleeding (most commonly ICH) |
|
|
Term
| management of bleeding (fibrinolytic complication) |
|
Definition
| stop infusion and administer reversal if indicated: cryoprecipitate (10 units); Platelets (6-8 units) |
|
|
