Which thrombolytic agents are used in the treatment of basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Thrombolytic agents include urokinase, pro-urokinase, streptokinase, and tPA. Urokinase is not on the market in the United States because of concerns regarding its production. Streptokinase has been discontinued by the manufacturer.

Pro-urokinase was tested in a prospective, randomized fashion. The trial involved only patients with occlusion of the middle cerebral artery stem. Results showed a better outcome in treated patients. However, pro-urokinase was not approved for use in acute stroke; therefore, the only option in the United States is tPA. This drug has been studied prospectively in trials involving combined IV and intra-arterial thrombolysis; the dosage used is 0.3 mg/kg, up to a maximum of 10-20 mg intra-arterially.

Because the rate of reocclusion is approximately 30%, some investigators have reported limited experience with the use of glycoprotein IIb/IIIa inhibitors, such as abciximab, to block platelet function and rethrombosis.


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