Fibrinolytic Therapy

Introduction

When primary PCI for patients with STEMI is not possible within a timely fashion, fibrinolysis is an important means of reperfusion.



Indications and Contraindications

Indications and Contraindications to Fibrinolytic Therapy



Fibrinolytic Agents

When fibrinolytic therapy is indicated, a fibrin-specific agent (alteplase, reteplase, or tenecteplase) is recommended over a nonfibrin-specific agent (eg, streptokinase) because of greater reperfusion success and less systemic bleeding with fibrin-specific agents.

  • Any fibrin-specific agent is acceptable as no drug has demonstrated superiority over the others with regard to the mortality benefit.

Fibrinolytic Therapy Dosing

Factors affecting the choice include

  • Risk of major bleeding
  • Ease of administration
  • Formulary restrictions



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