Thrombolytics
Turning plasminogen into plasmin, which breaks down the fibrin in clots.
Also called fibrinolytics.
Class card
- Drugs
- Alteplase and Tenecteplase
- Used for
- Acute ischemic stroke
- Acute heart attack (STEMI)
- Massive pulmonary embolism
- Known for
- Bleeding, above all inside the skull
- Name stems
- -plase
3 cards: the class, and each drug in it.
Mechanism of action
How do thrombolytics work?
They turn plasminogen into plasmin, the enzyme that cuts fibrin apart, so a clot that has already formed dissolves and the blocked vessel can reopen. Alteplase and tenecteplase are recombinant forms of tissue plasminogen activator: they bind fibrin in the thrombus and act mainly on the plasminogen trapped there, so circulating fibrinogen is broken down less.
The drugs
Thrombolytics with a card
Uses
What are thrombolytics used for?
- Acute ischemic stroke
- Acute heart attack (STEMI)
- Massive pulmonary embolism
Side effects
Side effects of thrombolytics
- Bleeding, above all inside the skullKnown forSerious
- Swelling of the tongue and lips (orolingual angioedema)Serious
- Anaphylaxis and other allergic reactionsSerious
- Cholesterol embolismSerious
- New emboli from broken-up clotsSerious
- Heart rhythm disturbances after reperfusionSerious
- Low blood pressure
- Nausea and vomiting
What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.
Watch for
Cautions
- Not used with internal bleeding, recent brain or spinal surgery or head injury, brain tumors or aneurysms, bleeding disorders, or severe hypertension.
- Acute ischemic stroke: rule out intracranial hemorrhage first, and treat as soon as possible within the licensed time window.
- Avoid intramuscular injections and unnecessary punctures; anticoagulants and antiplatelet drugs add to the bleeding risk.
- ACE inhibitors raise the risk of orolingual angioedema, so the airway is watched during and after treatment.
Remember them
A way to remember them
Lytics lyse: they make plasmin, and plasmin snips the fibrin that holds a clot together.
Their main danger follows from that action: bleeding, especially at puncture sites and inside the skull. Tranexamic acid works the opposite way, by keeping plasmin off fibrin.
Written for biofideX
Name stems
-plase means plasminogen activator (clot buster)
Alteplase and tenecteplase are tissue plasminogen activators that dissolve clots. WHO lists them under -ase (enzymes) as -teplase; urokinase-type ones end in -uplase.
- Every drug name stem
Don't mix them up
Classes easily confused with these
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Alteplase for injection: label (DailyMed)
- Tenecteplase for injection: label (DailyMed)
- Thrombolytic Agent (NCI Thesaurus)
- Tissue-Type Plasminogen Activator (NCI Thesaurus)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood clots and cholesterol
Practice thrombolytics with the other classes in this group: what each drug is, how it works, what it treats and what it's known for.
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