Which medications in the drug class Fibrinolytics (Thrombolytics) are used in the treatment of Septic Thrombophlebitis?

Updated: Oct 05, 2021
  • Author: JE Robyn Hanna, MD, MS; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Fibrinolytics (Thrombolytics)

The goal of fibrinolytic therapy is to dissolve an infected fibrin sheath or an infected thrombus that can serve as a nidus for resistant infection and as a source of septic emboli. Catheter-directed local infusions of fibrinolytic agents are safer than systemic fibrinolytic regimens because they use a low dose of the drug and usually do not produce a systemic lytic state. Several fibrinolytic agents are available for local-regional lysis of infected thrombus.

Reteplase (Retavase)

Reteplase is a second-generation recombinant tissue-type plasminogen activator. As a fibrinolytic agent, it seems to work faster than its forerunner, alteplase, and also may be more effective in patients with larger clot burden. In addition, reteplase has been reported to be more effective than other agents in the lysis of older clots. In patients being treated for peripheral vascular disease, reteplase has been reported to cause fewer bleeding complications than alteplase.

Alteplase (Activase)

Alteplase was the first recombinant tissue plasminogen activator to be released for clinical use; it is the agent with which EDs are most familiar.

Although alteplase is best known as a fibrinolytic agent used for coronary artery occlusion and pulmonary embolism, it is also widely used for catheter-directed lysis of deep venous thrombosis, for dissolution of catheter-related thrombus, and for reopening of occluded central lines and thrombosed dialysis grafts.

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