Urokinase

Characteristics

- Enzyme activator plazminoguena obtained from the cell culture kidney rights.

Of drugs

The drugs-fibrinoliticescoe. Activates and deep lizplazminoguena makes them a plazmin concern fermentativoe destruction fibrina. Dissolution fibrinova network leads to the disintegration of the building blocks of brain and split into small pieces, which moved shocks blood or dissolved on the ground plazminom. Late products fibrinoguena (D brochures and leaflets E) have a direct effect inotroponoe to Miocard.vazavaet clot lysis from the outside and from within. Increases airway and improves perfuziu attack. Formed degradation products fibrinoguena to gipokoagulyatsii, blocking agregatia cells, and platelets, reduce blood viscosity. After injecting gipokoagulie progress had been through 3-6 hours Productivity increases at reintroduce in combination with low doses of heparin. Before the therapy for the effective doses, it is necessary to define activity plazminoguena and antitrombina III trombinovogo time and fibrinoguena content in the blood. If plazminoguena depletion in the blood (heavy stenoziruty arteriosclerosis, retidivirutaya tromboembolia, heart attack, obesity, giperlipidemia) recommended that the large doses of the drug long course and the combination of fresh plasma and plazminoguena drugs. During pregnancy therapy can be ineffective because of the presence in the blood of high-level natural inhibitors Urokinaza.posle in / in the link with the squirrels and inaguiruetsa proteazami (alfa_2-macroglobulin, alfa_1-antitripsin, alfa_2-antiplazmin, antitrombin III). Small pieces of these complexes derived from the urine of up to 30-60 mg / sut. T_1/2 does not exceed 20 minutes. By reducing the kidney excretion significantly reduced.

Indications

Active arteritis and venous thrombosis, tromboembolia branches pulmonary artery, acute myocardial infarction during the first 3-6900, the unstable stenocardia, pulmonary shunt arteriovenoznogo, obliteriruty proper receptacles lower and upper limbs, hypertension primary pulmonary circulation.

Restrictions on the use of

The active form of tuberculosis, chronic renal or severe gepatozellliarnaya failure, aged age (after 70 years).

Contraindications

Bleeding (ongoing or recently stopped), incl. in the first 72 hours after the operation (especially neurosurgical), in a recent biopsy and Puncture artery (within 10 days), 10 days after giving birth; ulcers or stomach cancer, brain thrombosis (incl. history) expressed arterial hypertension, intracranial trauma, tumors brain coagulability of the blood (especially when expressed kidney or liver failure), tumor bleeding, acute pulmonary lung haemorrhagic diabetic retinopathy pozvonocna thrombosis or sleeping artery bacterial endocardit (podostry) began predserdy, mitralny stenoses, I trimester of pregnancy.

Side-Effects

Bleeding in the areas of white (especially with its length of more than 48 hours), bleeding (of gums, intestinal); Rarely purpura, embolisms fragments al primary brain fever, a moderate decrease in gematokrita.

Specific guidance

Treatment is carried out under the careful clinical (haemorrhagic syndrome, gematuria, etc.) and laboratory (every 4-6 hours) control. Fibrinoguena level in the blood must not fall below 100 mg%. After the cessation of therapy should be established in / in the heparin drip - 5,000 U every 12 hours under the supervision of trombinovogo and tromboplastinovogo time. In developing internal and external massive bleeding recommended that the introduction of the preparation. To stop bleeding (in the case of an emergency), use эпсилон-аминокапроно��ую acid human fibrinogen, transfusion of fresh blood.

Patient interaction

Increase the likelihood of bleeding drugs affecting blood coagulation (heparin), the function of platelets (NPVS, dipiridamol), leading to the development of izgyazwleni and bleeding from the digestive tract. Indirect combined and acetylsalicylic acid increases the risk of spontaneous bleeding in Mediastinum. Effect of inhibitors reduced fibrinolysis (эпсилон-аминокапроно вая acid, etc.).

Precautions

To use caution during the first 18 weeks of pregnancy (possible detachment placenta), in the case of rasslaivateisa anevrizma recently held cardiopulmonary resuscitation for the suspicion of damage to internal organs. Avoid the dekstranov to restore volume of circulating blood due to the potential for disaggregation platelets. Do not confuse one sprite or in the same solution for the on / in with the other drugs.

Dosing and Administration

In / in, in / but Local (endookulyarno, endoplevralno, endokoronarno). Prior to the on / in infusions active substance raise physiological solution, or 5% glucose solution. Are small, medium and high doses. Acute course introduces U 500,000 for 2 hours Therapy combined with constant / infuziei in small doses of heparin (1,000 U / kg per hour). Tromboembolia pulmonary artery in / 4,000 U / kg for 10 minutes, and within 12 to 24 hours continuous drip - 4,000 U / kg Regionarnoe introduction of a using angiographic catheter, for a period of 5 minutes to 2 hours Peripheral arteritis and venous thrombosis in / in the 20 minutes before entering nasashchatuyu dose of 250,000 U, and then continuously for 12h another 750,000 U. Myocardial infarction in / in during 6900 with the emergence of the first symptoms, type 250000 U followed infuziei 100000 U / h for 12 hours Intrakoronarno enter with plazminoguenom. Bleeding in the front chamber eye-bred sterile bidistilled water slowly, several times, washed the front camera eye. Fever arteriovenoznogo shunt : impose direct trombirovanny shunt and leave it for 1-2 hours

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