- Discussion: - converts plasminogen to plasmin, which degrades fibrin and
Fibrinogen; - indications: DVT,
PE, arterial thrombosis, or embolism; - contraindications: - stroke, intracranial surgery or neoplasm, active bleeding; - need to monitor CBC,
DIC panel, and TCT;
- Dose: - 250,000 units IV bolus over 30 min, then 100,000 units/hr continuous IV infusion for 24 to 72 hrs; - to minimize hypersensitively, administer 50 mg Benadryl IV or 100 mg
hydrocortisone IV before starting therapy;
- Monitoring therapy: - TCT 2-4 hrs after starting therapy and then qd; - a good fibrinolytic response is associatted w/ a TCT two-five x control - w/ massive bleeding occur during therapy: - stop SK, transfuse
pRBCs - infuse 5 units of
Cryoprecipitate (
Fibrinogen) until bleeding stops -
aminocarproic acid 4 gm IV followed by 1 gm/hr IV until bleeding stops;
