Urokinase

A to Z Drug Facts

 Action Converts plasminogen to plasmin, which then degrades fibrin clots and fibrinogen.

 Indications Management/dissolution of pulmonary emboli, coronary artery thrombosis; IV catheter clearance.

 Contraindications Active internal bleeding; history of cerebrovascular accident; recent (within 2 months) intracranial or intraspinal surgery or trauma; recent trauma including cardiopulmonary resuscitation; arteriovenous malformation or aneurysm; known bleeding diathesis; uncontrolled hypertension; intracranial neoplasm.

 Route/Dosage

Pulmonary Embolus

ADULTS: IV Priming dose of 4400 units/kg over 10 min, followed by continuous infusion of 4400 units/kg/hr for 12 hrs.

Lysis of Coronary Artery Thrombi

ADULTS: IV 4 ml/min (6000 units/min) for up to 2 hours; administer bolus dose of heparin prior to using urokinase.

IV Catheter Clearance

ADULTS: Inject 5000 IU/ml solution, equal to volume of catheter, into occluded catheter. Attempt aspiration q 5 min. If unopened after 30 min, cap catheter, wait 30 to 60 min and attempt aspiration. If unsuccessful, a second injection can be used.

 Interactions

Anticoagulants, antiplatelet agents: Bleeding complications may occur.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Bleeding. OTHER: Allergic reactions (eg, bronchospasm, skin rash); fever.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Arrhythmias: Rapid lysis of coronary thrombi may cause atrial or ventricular dysrhythmias. Bleeding: Can be either superficial (surface) bleeding or internal bleeding. Minor bleeding occurs often; several fatalities because of cerebral and other serious internal hemorrhages have occurred. High risk patients: Recent (within 10 days) major surgery or puncture of noncompressible blood vessel, obstetrical delivery, organ biopsy or serious GI bleeding; recent trauma including CPR; severe uncontrolled arterial hypertension; subacute bacterial endocarditis; hemostatic defects; pregnancy; age > 75 yr; cerebrovascular disease; diabetic hemorrhagic retinopathy; septic thrombophlebitis; other conditions in which bleeding may be hazardous. IV catheter clearance: Drug is not effective if catheter is occluded by substances other than fibrin clots.

 Administration/Storage

• Do not give via IM injection.
• Refrigerate vials of powder for injection. Store powder for solution at room temperature.
• Reconstitute powder for injection with Sterile Water for Injection.
• Further dilute powder for injection with 0.9% Sodium Chloride or D5W to prepare IV infusion solution. Do not use Bacteriostatic Water for Injection.
• Do not shake during reconstitution. Roll or tilt vial to enhance reconstitution.
• Filter through 0.45 micron or smaller cellulose membrane filter, as indicated.
• Do not add other medications to solution.
• Use immediately after reconstitution, and discard unused portion.
• Reconstituted catheter-clearing solution is stable for 24 hours at room temperature or under refrigeration.
• Administer with infusion control device. Use infusion pump for IV administration.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Before therapy, determine hematocrit, platelet count, thrombin time (TT), activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen levels. TT or aPTT should be less than twice the normal control value before therapy.
• Determine TT, PT, aPTT, or fibrinogen level 4 hr after starting infusion.
• Limit blood drawing as much as possible. Do not perform arterial puncture.
• During IV infusion, monitor vital signs q 4 hr.
• Do not take BP in lower extremities.
• Do not implement invasive procedures during infusion.
• Do not give with heparin.
• Monitor for allergic reactions (fever, bronchospasm, skin rash).
• Monitor for signs of internal or frank bleeding. Access mucous membranes, urine, and feces for blood.
• Monitor vital signs q 4 hours.
• Check urine, stools, and body secretions for occult blood.
• Assess skin for ecchymosis, edema, itching, rash, and bruising.
• Report chest pain to health care provider.
• Control minor bleeding with pressure for 30 minutes; then apply pressure dressing; do not reduce dose.
• With uncontrollable bleeding, discontinue infusion.

 Patient/Family Education

• Explain symptoms of internal and external bleeding.
• Teach application of pressure dressing for minor external bleeding.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts