1. BY :DR. ISRAA OMAR

2.  It is initiated concomitantly with coagulation cascade, resulting in the formation of active plasmin,which digest fibrin.  The main drug of this group are streptokinase and tissue plasminogen activator (tPA),for example alteplase  The main use is in acute STMI,acute stroke,clearing cannula,arterial thromboembolism and life threatening DVT and pulmonary embolism

6.  Is a non –enzyme protein extracted from culture of streptococci  It form stable complex with plasminogen and gains enzymic activity ;then causes fibrinolysis  The major adverse effect is bleeding include GI Hemorrhage and stroke  Hemorrhage can be treated with traneximic acid  Hypotension and hypersensitivity may also recorded

7.  Both are recombinant tissue plasminogen activators.  Alteplase is a single chain where as duteplase is a double chain  They preferentially plasminogen that is bound to fibrin,they are said to be clot selective.  They dissolve formed thrombus and avoid systemic activation of plasminogen  They can cause hemorrhage but less than streptokinase  No hyper sensitivity reaction occur with them

8. 1. Active internal bleeding 2. Bleeding diatheses 3. Pregnancy 4. Uncontrolled hypertension 5. CPR(Cardio-plumonary resuscitation) 6. Recent major surgery or Eye surgery 7. Recent hemorrhagic stroke

9. BY:DR ISRAA OMAR

10.  Both are synthetic agents  Work by inhibition of plasminogen activation  They are orally active  A potential side effect of treatment is intravascular thrombosis

11.  It stops bleeding by blocking plasmin  It can inhibit streptokinase  It is used to reduce blood loss in patients undergoing cardiopulmonary bypass surgery  Side effect include anaphylactic reaction if there is previous exposure within 12 month, renal dysfunction is also reported with the use of this drug

12.  Antagonizes the anticoagulant effect of heparin  It is derived from fish sperm and testes and has a high content of arginine which make it basic drug  It is positive charge neutralize the negative charge of heparin thus making a stable complex and prevent the action of heparin  Side effect include dyspnea, flushing, hypotension and bradycardia especially when injected rapidly

13.  It antagonize the action of oral anticoagulant  The action of vitamin k start after 24 hours ;thus,if immediate action is required,fresh frozen plasma should be infused

14. Thank you