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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Monday, December 20, 2021

Thrombolytic Use for STEMI

emDocs - December 19, 2021 - By Scott Fitter; Kimberly Won; Kayvan Moussavi
Reviewed by Alex Koyfman; Brit Long
Take Home Points: 
  • Thrombolytics (also called fibrinolytics) serve as tissue plasminogen activators (work by converting plasminogen to plasmin), which break the crosslinks between fibrin molecules to destabilize the structural integrity of blood clots.
  • Thrombolytics can be useful when treating life-threatening clotting disorders (e.g. acute ischemic stroke, pulmonary embolism, STEMI).
  • In general, thrombolytics should be avoided in patients with active hemorrhage or at high risk of hemorrhage in a critical location (e.g. recent spinal or intracranial surgery or trauma).
  • Bleeding (internal and external) and hypersensitivity reactions (e.g. angioedema) can occur after thrombolytic administration.
  • Non-selective thrombolytics (e.g. urokinase, streptokinase) tend to cause more adverse effects compared to fibrin-selective thrombolytics (e.g. alteplase, tenecteplase, reteplase).
  • Thrombolytic therapy for STEMI is recommended if the anticipated time to PCI is greater than 120 minutes from the first medical contact, the patient presents within 12 hours of ischemic symptom onset, and does not have any contraindications to thrombolytic therapy.
  • Fibrin-selective thrombolytic agents (e.g. tenecteplase, reteplase, alteplase) are preferred over non-selective agents (e.g. urokinase, streptokinase) for STEMI.
  • Patients treated with thrombolytics for STEMI should receive concurrent antiplatelet agents (e.g. aspirin with clopidogrel) and anticoagulants (e.g. enoxaparin, UFH).
  • Due to increased risk of bleeding, GP IIb/IIIa inhibitors should not be used with thrombolytics when treating STEMI.