Get certified in ACLS Recertification for just $175.00.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
Alright, now let’s talk about something that is usually found - not necessarily in the advanced cardiac life support pharmacological drug cart specifically - but is vitally important to reperfusion therapies. We’re going to talk about fibrinolytic drugs. You see, fibrinolytic drugs, also called thrombolytic drugs, are any medication that’s capable of stimulating the dissolution of a blood clot sometimes referred to as a thrombus. These types of drugs work by activating something referred to as the fibrinolytic pathway. Now this is important because it differentiates them from the anticoagulant drugs which are commonly known as coumarin derivatives and heparin. Now these drugs, which prevent the formation of blood clots by suppressing the function of multiple clotting factors that are normal and present in the blood, are different from anticoagulants. The most common indications for the use of fibrinolytic medications include acute myocardial infarction and acute ischemic stroke. In AMI patients, it would be indicated if the ST-segment elevation is consistent with an MI of greater than or equal to 1mm in two or more contiguous leads. It may also be indicated if the signs and symptoms of AMI last more than 15 minutes and less than 12 hours and PCI is not available within 90 minutes of medical contact. Now if the indication is related to Ischemic Stroke, patients may qualify if they suffer sudden onset of focal neurologic deficit like slurred speech, facial droop, one sided weakness or one sided paralysis. The stroke symptoms do not seem to be self resolving which is kind of what we’ve seen when it’s a transit-ischemic attack known as a TIA and the signs and symptoms are present for up to 3 hours but not greater than 4 and a half hours. With fibrinolytic drugs there are reasons to exclude the use and they include but may not be limited to the following: Hypertension with systolic blood pressure greater than 180-200 mm of Mercury. A right arm versus left arm blood pressure difference greater than 15 mm of Mercury. Significant head or facial trauma within the past 3 months. Prior intracranial hemorrhage. Bleeding disorder or internal bleeding within the last 2 to 4 weeks. They’re on a current anticoagulant treatment. Pregnant. Maybe they have Ischemic Stroke greater than 3 hours or less than 3 months not to include the current condition being considered for the current fibrinolytic treatment and serious systemic disease which would include advanced cancer or kidney disease. So, the adult dosage for fibrinolytic treatments can be a little bit complex because the dose of fibrinolytic treatment depends on the fibrinolytic being used.
In this lesson, we'll go over the use of fibrinolytic medications and all of their effects, including indications, precautions and contraindications, and adult dosages.
Fibrinolytic medications are not usually found in advanced cardiac life support pharmacological drug cards specifically. However, their use is vitally important to reperfusion therapies.
Fibrinolytic drugs – also called thrombolytic drugs – are any medication that is capable of stimulating the dissolution of blood clots, or as they're sometimes referred to as – thrombus. These types of drugs work by activating something referred to as fibrinolytic pathways.
Pro Tip #1: This is important because it differentiates fibrinolytic medications from anticoagulant drugs, routinely referred to as heparin and Coumadin – Two common anticoagulants that work by preventing normal clotting factors from functioning correctly, thereby inhibiting the blood from clotting.
Fibrinolytic medications, which prevent the formation of blood clots by suppressing the function of multiple clotting factors that are normal and present in the blood, are different from anticoagulants.
Pro Tip #2: There are numerous fibrinolytic agents on the market, each of which may produce varying mechanisms of action. And while there are similarities between these are anticoagulants, fibrinolytic drugs produce the therapeutic effect of breaking down the fibrin and fibrinogen matrix of a thrombosis (fibrinolysis), thus fragmenting the clot that is obstructing an artery and reestablishing distal blood flow.
Now let's take a look at some indications for fibrinolytic medications.
The most common indication for the use of fibrinolytic medications include the following two:
In patients with acute myocardial infarction, fibrinolytic drugs would be indicated if the ST-segment elevation is consistent with a myocardial infarction of greater than or equal to 1mm in two or more contiguous leads. Contiguous leads are next to one another anatomically speaking. They view the same general area of the heart (specifically the left ventricle).
Fibrinolytic drugs can also be indicated if the signs and symptoms of a myocardial infarction last longer than 15 minutes and less than 12 hours and if PCI (percutaneous coronary intervention) is not available within 90 minutes of medical contact.
If the indication is related to ischemic stroke, patients may qualify if they suffer from sudden onset of a focal neurological deficit such as:
Patients may also qualify for fibrinolytic medications if the stroke symptoms do not seem to be self-resolving, which is what you usually see when it's a transient ischemic attack (or TIA) and the signs and symptoms are present for up to three hours but not greater than 4.5 hours.
There are a few precautions and contraindications when it comes to administering fibrinolytic medications that you should be aware of.
When using fibrinolytic drugs, there are several patient factors that would exclude their use, which include (but are not limited to):
Pro Tip #3: However, that last contraindication would not include the current condition being considered for the current fibrinolytic treatment.
The adult dosage for fibrinolytic treatments can be a little complex because the dose of the treatment would depend on the exact fibrinolytic medication being used.
Having said that, there are three major classes of fibrinolytic drugs: tissue plasminogen activator (tPA), streptokinase (SK), and urokinase (UK). While drugs in these three classes all have the ability to effectively dissolve blood clots, they differ in their detailed mechanisms in ways that alter their selectivity for fibrin clots.