Anistreplase
Pronouncation: (uh-NISS-truh-place)
Class: Thrombolytic
Trade Names:
Eminase
- Powder for injection, lyophilized 30 units (potency is expressed in units of anistreplase by using a reference standard that is specific for anistreplase and is not comparable with units used for other fribrinolytics)
Mechanism of Action
Pharmacology
Aids in dissolution of blood clots.
Pharmacokinetics
Metabolism
Deacylation of anistreplase forms lys-plasminogen-streptokinase activator complex (active).
Elimination
T ½ of fibrolytic activity is approximately 94 min.
Indications and Usage
Lysis of obstructing coronary thrombi for management of acute MI.
Contraindications
Hypersensitivity to streptokinase; active internal bleeding; history of cerebrovascular accident; recent (within 2 mo) intracranial or intraspinal surgery or trauma; intracranial neoplasm; arteriovenous malformation or aneurysm; known bleeding diathesis; uncontrolled hypertension.
Dosage and Administration
Adults
IV 30 units over 2 to 5 min into IV line or vein. Reconstitute powder with 5 mL of sterile water for injection. Do not shake vial during reconstitution; try to minimize foaming. Do not further dilute reconstituted anistreplase.
Storage/Stability
Store lyophilized anistreplase under refrigeration. Discard any reconstituted anistreplase not administered within 30 min of reconstitution.
Drug Interactions
Anticoagulants (eg, heparin, warfarin) and antiplatelet agents (eg, aspirin, dipyridamole)
May increase risk of bleeding.
Incompatibility
Do not add to any infusion fluids. Do not add other medications to vial or syringe containing anistreplase.
Laboratory Test Interactions
Can cause decreases in plasminogen and fibrinogen levels and increases in thrombin time, activated PTT and PT, making results of coagulation tests unreliable.
Adverse Reactions
Cardiovascular
Arrhythmia and conduction disorders; hypotension.
Hematologic
Bleeding at puncture site, nonpuncture-site hematoma; hematuria; hemoptysis; GI hemorrhage; intracranial bleeding; mouth and gum hemorrhage; epistaxis; ocular hemorrhage; nonspecific hemorrhage.
Precautions
Monitor
Bleeding
Monitor diligently for signs or symptoms of internal or surface bleeding. Remember that lab values for coagulation tests and measurements of fibrinolytic activity after anistreplase therapy may be unreliable.
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Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Hypersensitivity
Rarely, anaphylactic and anaphylactoid reactions (with bronchospasm or angioedema) may occur.
Arterial puncture
If arterial puncture is necessary after administration of anistreplase, it is preferable to use upper extremity vessel that is accessible to manual compression. Apply pressure dressing; check puncture site frequently for evidence of bleeding. Control minor bleeding with manual pressure.
Epinephrine
Have epinephrine and emergency treatment provisions available during administration of anistreplase.
Readministration
Because of formation of antistreptokinase antibody, anistreplase may not be effective if administered more than 5 day to 6 mo after prior anistreplase or streptokinase therapy or after streptococcal infection.
Patient Information
- Explain to patient the need for bedrest and minimal handling of patient.
- Instruct patient to report the following symptoms to health care provider: bruising, bleeding, hypersensitivity reactions (eg, urticaria, flushing, itching, rashes).
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
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