anistreplase

anistreplase /an·is·trep·lase/ (an″is-trep´lās) a thrombolytic agent used to clear coronary vessel occlusions associated with myocardial infarction.

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anistreplase,

a plasminogen activator.

indication This drug is used in acute MI for lysis of coronary artery thrombi.

contraindications Known hypersensitivity to this drug or streptokinase; active internal bleeding; intraspinal or intracranial surgery; central nervous system neoplasms; severe, uncontrolled hypertension; cerebral embolism; thrombosis; hemorrhage; recent trauma; or history of cerebrovascular accident all prohibit the use of this drug.

adverse effects Adverse effects of this drug include headache, fever, sweating, agitation, dizziness, paresthesia, tremor, vertigo, hypotension, conduction disorders, nausea, vomiting, decreased hematocrit, surface bleeding, rash, urticaria, phlebitis at the injection site, itching, flushing, low back pain, arthralgia, altered respirations, and dyspnea. Life-threatening side effects include intracranial hemorrhage, dysrhythmias, GI bleeding, genitourinary bleeding, intracranial bleeding, retroperitoneal bleeding, thrombocytopenia, bronchospasm, lung edema, and anaphylaxis.

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anistreplase (anisoylated plasminogen streptokinase activator complex, APSAC)

Eminase

Pharmacologic class: Plasminogen activator

Therapeutic class: Thrombolytic enzyme

Pregnancy risk category C

Action

Combines with plasminogen to form activated complex, which converts plasminogen to plasmin and causes lysis of thrombi in arteries

Availability

Powder for injection: 30 units/vial

⊘Indications and dosages

➣ Management of acute myocardial infarction (MI), including lysis of thrombi obstructing coronary arteries, reduction of infarct size, improvement of ventricular function, and prevention of death

Adults: 30 units by direct I.V. injection given over 2 to 5 minutes, starting as soon as possible after onset of acute MI symptoms

Contraindications

• Hypersensitivity to anistreplase or streptokinase
• Active or recent internal bleeding
• Cerebrovascular accident within past 2 months
• Aneurysm
• Uncontrolled hypertension
• Severe hepatic disease
• Breastfeeding

Precautions

Use cautiously in:
• hemorrhagic conditions, hepatic or renal disease
• patients receiving warfarin concurrently
• elderly patients
• pregnant patients
• children.

Administration

• Dilute powder with 5 ml of sterile water for injection.
• Don't further dilute reconstituted solution before giving drug or adding to infusion fluids.
• Don't add other drugs to vial or syringe.
• Gently roll vial to mix. To minimize foaming, don't shake.

Route	Onset	Peak	Duration
I.V.	Immediate	45 min	4-6 hr

Adverse reactions

CNS: dizziness, fever, headache, intracranial hemorrhage

CV: conduction disorders, hypotension, arrhythmias

EENT: epistaxis

GI: nausea, vomiting, abdominal pain, constipation, GI hemorrhage

GU: hematuria, proteinuria, vaginal bleeding

Hematologic: eosinophilia, bleeding tendency

Musculoskeletal: joint pain or stiffness, myalgia, back or bone pain

Respiratory: hemoptysis, dyspnea, bronchospasm

Skin: hematoma, urticaria, pruritus, flushing, angioedema, delayed purpuric rash

Other: bleeding at puncture site, ankle edema, chills, fever, gum or mouth hemorrhages, shock, anaphylaxis

Interactions

Drug-drug. Drugs that alter platelet function (such as aspirin, dipyridamole, heparin, oral anticoagulants): increased bleeding risk

Drug-diagnostic tests. Alpha₂-antiplasmin, factor V, factor VIII, fibrinogen and plasminogen activity, hematocrit, hemoglobin: decreased values

Eosinophils, International Normalized Ratio, partial thromboplastin time, prothrombin time: increased values

Patient monitoring

☞ Monitor patient for signs and symptoms of anaphylaxis.
☞ Watch for bleeding tendency and hemorrhaging.
• Assess neurologic status and vital signs regularly.
• Evaluate patient for arrhythmias, conduction disorders, and hypotension.
• Monitor CBC and blood coagulation studies.

Patient teaching

• Tell patient to report signs and symptoms of allergic reaction.
• Instruct patient to report unusual bleeding or bruising.
• Caution patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Explain to patient that he will be on bed rest during entire course of treatment and will be monitored closely.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Caution patient not to use aspirin during therapy.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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anistreplase

See APSAC.