Fibrinolytic Agents

• Commonly used fibrinolytic agents: t-PA, Urokinase, Alteplase, Streptokinase, TNKase
• Half-life of fibrinolytic agents: 5 to 20 minutes
• Discontinue fibrinolytic agent infusion
• Stat labs to be sent: CBC, platelet count, fibrinogen, type & cross, CMP (comprehensive metabolic panel)
• Primary reversal agents:
  • Cryoprecipitate infusion: Target fibrinogen levels: ≥ 100 mg/dL (hemostatic level of fibrinogen: 75-100 mg/dL)
    • Children: 1 unit/5 kg
    • Adults: 10 units
  • Antifibrinolytics: Used in addition to cryoprecipitate with life/organ/limb threatening hemorrhage
    • Aminocaproic acid: 50-100 mg /kg I.V. (maximum 5 grams) I.V. bolus, followed by 30 mg/kg/hr (maximum 1.25 g/hr) until bleeding stops or until maximum dose of 18 grams is reached
    • OR Tranexamic acid (I.V. form available only): 10 mg/kg q 3-4 hrs
• Adjunctive agent: Platelet transfusion: Fibrinolytic treatment causes platelet dysfunction
  • Children: 10 mL/kg
  • Adults: 1-2 units of single apheresis units (6-12 units of random donor platelets)
• If significant bleeding, check CBC, platelet count, coagulation studies and follow specific guidelines for use of blood products
• rVIIa: Use of rVIIa should be restricted to intracerebral bleeding and major intracavitary bleeding
• rVIIa should be used cautiously in patients with previous history of coronary events or in patients with a predisposition to coronary events
  • Dose: 90 mcg/Kg q 2-4 hrs OR continuous infusion 10-30 mcg/kg/hr