THROMBOLYSIS
see Contraindications
Monitoring/Observation
- PR, BP @ 15min
- Continuous ECG monitoring (preferably with
continuous ST segment)
- GCS @ 15min
Complications
- Acute GI bleeding - stop infusion
- Haemorrhagic stroke - stop infusion, urgent CT
brain
- 'Reperfusion arrhythmias' in AMI - self-terminating and rarely requiring
treatment
Treatment of bleeding complications
- FFP
- Cryoprecipitate
- E-Aminocaproic acid (EACA)
Streptokinase
TPA
Tenecteplase (TNK)
Streptokinase
Indications
Contraindications
- see above
- Previous SK > 6 weeks ago (formation of
neutralising antibodies)
Dose and Administration
- 1,500,000 units Streptokinase in 50 ml 5%
dextrose
- Infuse over 45 minutes at 67 ml/hr
Complications
- Hypotension - assess for blood
loss, fluid bolus, halve infusion rate temporarily until BP improves
Tissue Plasminogen activator (TPA, Altepase)
Indications
- AMI < 12 hrs with ECG
criteria
- Non-haemorrhagic moderately severe CVA < 3
hrs (experimental)
- Massive PE (hypoxia, hypotension)
Dose and Administration
Front loaded
- 15mg/5min
- 35 mg/30 min
- 50 mg/30 min
Continuous
Tenecteplase (TNK)
Dose and Administration
- 0.5mg/kg bolus over 5 sec (mix in 10ml of sterile water)