Which medications in the drug class Thrombolytic Agents are used in the treatment of Venous Thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Thrombolytic Agents

As stated by the American College of Chest Physicians, [35]  thrombolytic treatment is indicated for acute, massive PE with hemodynamic instability in patients who do not seem prone to bleeding. These agents dissolve recent clots promptly by activating a plasma proenzyme, plasminogen, to its active form, plasmin. Plasmin degrades fibrin to soluble peptides.

Thrombolytic therapy speeds pulmonary tissue reperfusion and rapidly reverses right heart failure. It improves pulmonary capillary blood flow and more rapidly improves hemodynamic parameters.

Reteplase; t-PA (Retavase)

Reteplase is used in the management of PE in hemodynamically unstable patients. Its safety and efficacy with concomitant administration of heparin or aspirin during first 24 hours after symptom onset have not been investigated.

Tenecteplase (TNKase)

Tenecteplase is a modified version of alteplase made by substituting three amino acids. It has a longer half-life than alteplase and thus can be given as a single bolus infused over 5 seconds (as opposed to the 90 minutes required for alteplase). It appears to cause less non–intracranial bleeding than alteplase but carries a comparable risk of intracranial bleeding and stroke.

Base the dose on the patient's weight. Initiate treatment as soon as possible after the onset of AMI symptoms. Because tenecteplase contains no antibacterial preservatives, it must be reconstituted immediately before use.

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