- 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