Adverse Reactions to Thrombolytic Agents

Nazari, Jose; Davison, Richard; Kaplan, Kerry; Fintel, Dan J.

doi:10.1007/bf03259869

Cited by 11 publications

(4 citation statements)

References 73 publications

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“…The elderly population is more likely to experience streptokinase adverse effects, particularly bleeding and hypotension [16,17]. Similarly, in our study, we found the incidence of adverse effects to be higher in Group C (mean age: 66 ± 2 years) compared with Group A (mean age: 39 ± 3 years).…”

Section: Discussionsupporting

confidence: 81%

Efficacy of Low-Dose Streptokinase Infusion in Late-Onset Permanent Tunnel Catheter Dysfunction: A Single-Center Interventional Study

Gadekar,

Kibriya,

Kulkarni

et al. 2024

Cureus

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IntroductionHemodialysis is a vital modality for patients with renal dysfunction, with venous access being a significant factor in its success. While arteriovenous fistulas are preferred, tunneled catheters serve as important alternatives, especially in challenging cases. Late-onset tunneled catheter dysfunction, often due to fibrin sheath formation, impedes hemodialysis efficiency. Streptokinase, a low-cost thrombolytic agent, has shown promise in resolving such complications, yet its efficacy in the Indian context remains unexplored. MethodsWe conducted a single-center interventional study at Mahatma Gandhi Mission (MGM) Hospital, Aurangabad, India, from May 2023 to October 2023. Ethical approval was obtained, and 10 eligible patients experiencing late-onset permanent tunnel catheter dysfunction were enrolled. Patients were treated with low-dose streptokinase, and outcomes were monitored for 60 days. ResultsTen patients, evenly distributed by gender, participated, with a mean age of 48.2 ± 11.96 years. Diabetes was the predominant cause of chronic kidney disease (CKD) at 33% (3/10). All patients achieved the primary endpoint of blood flow rate (BFR) >300 ml/min post-streptokinase treatment, with an overall success rate of 100%. Group A had the highest average gain in catheter days (80.6 ± 7.59), followed by Group B (64 ± 1), while Group C showed variations in catheter days between the first (26.2 ± 6.8) and second insertion (32.5 ± 1.76). Eight patients maintained catheter patency during the 60-day follow-up. Adverse effects, primarily minor, were observed. The dosage rationale involved an eight-hour infusion at 4,000 units per hour. ConclusionStreptokinase emerges as cost-effective and efficacious for maintaining the patency of late-onset tunnel catheter dysfunction in resource-limited settings, particularly in younger patients. Caution is advised for older individuals with prolonged CKD.

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Section: Discussionsupporting

confidence: 81%

Efficacy of Low-Dose Streptokinase Infusion in Late-Onset Permanent Tunnel Catheter Dysfunction: A Single-Center Interventional Study

Gadekar,

Kibriya,

Kulkarni

et al. 2024

Cureus

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“…There are several thrombolytic agents that differ in cost, antigenicity and currently more investigations are being directed to find safer and more effective thrombolytic agents. Nevertheless, the thrombolytic agents are associated with hypotension, arrhythmias and hemorrhagic complications,[20] which might be a risk of intracranial bleeding and many more systemic or major bleeding risks and death. It was interesting to find the knowledge of paramedics regarding the risks of thrombolysis therapy.…”

Section: Discussionmentioning

confidence: 99%

Paramedics beliefs and attitudes towards pre-hospital thrombolysis

Alanazi

Alrashidi

Aljerian

2014

Int J App Basic Med Res

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Background:Myocardial infarction is the third leading cause of death in the developing countries. Thrombolysis as a reperfusion therapy is shown to have a great role in decreasing mortality. The efficacy of thrombolytic therapy lies in its ability to reduce the duration of occlusion by early administration. Many of the studies have supported pre-hospital thrombolysis (PHT) therapy and proven that it is beneficial in acute myocardial infarction (AMI) patients.Methodology:Questionnaires adopted from studies of Humphrey et al., were distributed to paramedics in Saudi Red Crescent Authority and Emergency Medical Services Departments at King Abdulaziz Medical City, King Fahad Medical City, Prince Sultan Medical Military City and Security Forces Hospital in Riyadh. A total of 7 questions were about the knowledge of risk and benefit of PHT and 12 questions were about the beliefs and attitudes of paramedics toward PHT in AMI patients.Results:The response rate was 87%. Nearly 72% were believed to be capable of performing PHT, 87% are confident about recording 12-lead electrocardiogram in pre-hospital settings and 77% are confident in the interpretation. 94% believe that PHT will have a significant impact on pain to needle time. 77% consider PHT to be safe for use by paramedics. 66% preferred on-line medical direction or telemedicine linked with the supervision of a physician. Regarding the knowledge part, majority gave a correct answer, but the major concern was that 43% of the paramedics overestimated direct relation of bleeding to thrombolysis therapy.Conclusion:Majority of paramedics in Riyadh support the principle of PHT in patients with AMI via online medical direction. They believe that they are confident in their ability to administer PHT despite the concern of authorities on their level of training, the related risks and medico-legal issues. Nevertheless, since the total duration of PHT course for paramedics is just 2 days, we consider that the procedure should be performed under expert supervision until they achieve expertise.

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“…Although they can be effective, thrombolytics may greatly effect hemostasis, resulting in some significant side effects. 62 Instead of treating blood clots, drugs such as captopril and ramipril can reduce the load on blood vessels. 63 These belong to the class of angiotensin-converting enzyme inhibitors that work by decreasing angiotensin II levels.…”

Section: Current Clinical Managementmentioning

confidence: 99%