The goals of pharmacotherapy are to reduce morbidity and prevent complications.
These agents dissolve recent clots promptly by activating a plasma proenzyme, plasminogen, to its active form, plasmin. Plasmin degrades fibrin to soluble peptides. The potential benefits of thrombolytic therapy for the treatment of thrombosis include fast dissolution of physiologically compromising emboli, faster recovery, prevention of recurrent thrombus formation, and rapid restoration of hemodynamic disturbances.
The use of catheter-directed thrombolytic therapy may be indicated for superimposed clot formation in an area of stenosis until definitive treatment of the obstruction can be undertaken.
Alteplase, or tissue plasminogen activator (tPA), exerts an effect on the fibrinolytic system to convert plasminogen to plasmin. Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII. The serum half-life of alteplase is 4-6 minutes but is lengthened when the drug is bound to fibrin in clot.
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