When a thrombus already has formed, fibrinolytics or thrombolytics can be used to lyse the thrombus. Thrombolytics activate the conversion of plasminogen into plasmin. The latter enzyme lyses the fibrin network in the thrombus. Exogenous tPA enforces the activation of plasminogen. Streptokinase forms a complex with plasminogen, which enhances the transition from plasminogen into plasmin.
Thrombolysis is important in the treatment of an acute myocardial infarction and more recently cerebral infarction. It is not used in case of deep vein thrombosis and only occasionally in case of severe, life-threatening pulmonary embolism. Streptokinase, alteplase, reteplase and urokinase are the mostly used thrombolytics. Main adverse effect is bleeding.
What is not true? The use of thrombolytics by GPs in the management of suspected myocardial infarction is indicated if:
When the clotting proteins are removed from the plasma, . . . . . remains.