For the lysis of acute massive pulmonary emboli,defined as obstruction of blood flow to a lobe or multiple segments. ? For the lysis of pulmonary emboli accompanied by unstable hemodynamics,i.e.,failure to maintain blood pressure without supportive measures.
Fibrinolytics (Thrombolytics)
Deep vein thrombosis: Initial loading dose of 4,400 IU/kg in 15 mL soln over 10 min,followed by 4,400 IU/kg/hr IV infusion for 12-24 hr. Pulmonary embolism: Initial loading dose of 4,400 IU/kg in 15 mL soln over 10 min followed by 4,400 IU/kg/hr IV infusion for 12 hr. Peripheral vascular occlusion: Infuse 2,500 IU/mL (500,000 IU in 200 mL) into clot at a rate of 4,000 IU/min for 2 hr. Advance the catheter into the remaining occluded area & infuse at 4,000 IU/min for another 2 hr. This may be repeated up to 4 times. Hyphaema: 5,000 IU in 2 mL saline soln is injected and withdrawn repeatedly over the iris. If residual clot remains,leave 0.3 mL in the anterior chamber for 24-48 hr to facilitate further dissolution. Clotted arterio-venous shunts: Instill 5,000-25,000 IU into affected shunt limb & clamp for 2-4 hr,followed by aspiration of lysate. Repeat if necessary.
Because thrombolytic therapy increases the risk of bleeding,It is contraindicated in the situations listed below ? Active internal bleeding ? Recent (e.g.,within two months) cerebrovascular accident ? Recent (e.g.,within two months) intracranial or intraspinal surgery ? Recent trauma including cardiopulmonary resuscitation ? Intracranial neoplasm,arteriovenous malformation,or aneurysm ? Known bleeding diatheses ? Severe uncontrolled arterial hypertension
fatal hemorrhage and anaphylaxis
Pregnancy Pregnancy Category B: Reproduction studies have been performed in mice and rats at doses up to 1,000 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to It. There are,however,no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response,this drug should be used during pregnancy only if clearly needed. Nursing Mothers It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk,caution should be exercised when It is administered to a nursing woman.
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