Which medications in the drug class Thrombolytics are used in the treatment of Inferior Vena Caval Thrombosis?

Updated: Jun 12, 2018
  • Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, KHS, KCOEG; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Thrombolytics

Most thrombolytic agents have been reported in the treatment of IVCT. The relative merits of thrombolytic therapy must be weighed against the risks of hemorrhagic complications.

Thrombolytic agents are used to dissolve a pathologic intraluminal thrombus or embolus that has not been dissolved by the endogenous fibrinolytic system. They are also used for the prevention of recurrent thrombus formation and rapid restoration of hemodynamic disturbances. Urokinase, tissue-type plasminogen activator (tPA), and streptokinase have all been used. Typically, delivery is catheter directed with or without a pulse spray. Patients require concurrent heparin therapy; however, tPA protocols do not use concurrent heparin because of the risk of bleeding complications. This therapy may play the greatest role as part of combination therapy with endovascular interventions.

Urokinase

Urokinase is a direct plasminogen activator isolated from human fetal kidney cells grown in culture. It acts on endogenous fibrinolytic system and converts plasminogen to enzyme plasmin. Plasmin degrades fibrin clots, fibrinogen, and other plasma proteins. Urokinase is nonantigenic but more expensive than streptokinase, which limits its use. When used for purely local fibrinolysis, it is administered as local infusion directly into area of thrombus and with no bolus. The dose must be adjusted to achieve clot lysis or patency of the affected vessel.

Streptokinase (Streptase)

Streptokinase acts with plasminogen to convert plasminogen to plasmin. Plasmin degrades fibrin clots as well as fibrinogen and other plasma proteins. An increase in fibrinolytic activity that degrades fibrinogen levels for 24-36 hours takes place with intravenous (IV) infusion of streptokinase.

Alteplase (Activase, Cathflo Activase)

Alteplase is a tPA used in the management of acute myocardial infarction, acute ischemic stroke, and PE. Safety and efficacy with concomitant administration of heparin or aspirin during the first 24 hours after symptom onset have not been investigated.


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