How and when to apply Urokinase: indications, instructions and reviews

Urokinase( Urokinase) belongs to the group of fibrinolytic drugs.

The drug is available as a lyophilizate for infusion administration.

Represents a sintered mass or white powder.

Each vial of the preparation contains the active substance "urokinase" in four possible dosages:

• 10000 IU;
• 50000ME;
• 100,000 IU;
• 500000 IU.

Pharmacological action

The medicamentis a direct activator of fibrinolysin, which is converted from glu- and lysprofibrinolysin byX activation.

Fibrinolysin, in turn, contributes to the destruction of fibrin, which dissolves the thrombus. The degradation products of fibrinogen, which are formed much later, show a direct inotropic effect on the myocardium, which contributes to hypocoagulation, blockade of aggregation of erythrocytes, platelets and a decrease in the viscosity of the blood.

Urokinase is administered exclusively intravenously or by intra-arterial droplet. The process of transformation of the main active substance occurs in the liver, and inactive metabolites are excreted with bile and urine.

The half-life of the drug is no more than 16 minutes, but the effect of its administration is maintained up to 6 hours.

Indications for use

Use of the drug Urokinase is possible in the presence of a patient:

• thrombosis and thromboembolism of veins and arteries;
• pulmonary embolism;
• acute myocardial infarction;
• unstable angina;
• deep vein thrombosis;
• Hemophthalmus;
• chronic meningitis;
• coronary thrombosis;
• obliterating atherosclerosis of the vessels of the hands and feet.

Contraindications and limitations

In the course of clinical trials, it was possible to identify such conditions and diseases in which the use of the drug is prohibited:

• in the presence of allergic reactions to the constituent components of the drug;
• bleeding of any origin;
• possibility of bleeding in various diseases and neoplasms in the body;
• low rates of blood coagulation;
• presence of pulmonary edema, hematoma, tumor, development of diabetic hemorrhagic retinopathy;
• endocarditis in subacute phase and other heart diseases;
• circulatory disorders in the brain and the presence of a history of hemorrhagic stroke, intracranial bleeding or ischemic attacks;
• arterial hypertension, in which the systolic and diastolic pressures are at a high level, and the disease itself can not be controlled;
• pancreatitis in the acute phase of the course;
• the first three months of pregnancy;
• children who have not reached the age of 18;
• Patients over 70 years of age are advised to use the drug with caution.

Dosage and administration regimens

The following Urokinase administration is possible:

• intravenous drip;
• intra-arterial;
• internal gas;
• intrapleural( in the pleural space);
• intracoronary( in the coronary vessels).

Use the preparation immediately after dissolution in physiological saline( 0.9% NaCl).In parallel with the administration of the drug, intravenous infusion of Heparin is carried out and the activated partial thromboplastin time( APTT) is monitored.

Scheme and dosages depending on the patient's condition:

1. With pulmonary embolism of the pulmonary artery, the treatment starts with a dosage of 4000 IU / kg, which is administered within 15 minutes. In the future, during the day, they support therapy with the same dose of the drug. For regional administration, it is necessary to dilute 0.03-1 million IU in 50 ml of saline and administer the drug with an angiographic catheter.
2. Arterial and vein thrombosis : initial treatment 1500 mU / kg, which is administered for an hour, and maintained with 1000-200 MU / kg / h. Treatment in this way, together with therapy with Heparin, is carried out until the thrombus is disrobed.
3. Myocardial infarction and severe thromboembolism is treated with a dose of 15,000 IU / kg, which is administered once for 10 minutes. Intracoronary administration is combined with Profibrinolysin.

Cases of overdose and side effects of

The only symptom of an overdose is profuse bleeding. The main method of stopping this state is to perform compression.

If this method manifests itself as ineffective, then the use of Urokinase stops, and it is replaced with hemostatics.

Aprotinin is one of the drugs used to stop bleeding. It is administered at a dose of 500,000 to 1 million KIE / h, followed by a decrease to 50-100 thousand KIE / h.

All measures to eliminate overdose are in the presence of transfusiologists and hemostasists.

On the frequency of occurrence it is possible to single out such side effects after the use of the medicine:

• appearance of hematomas;
• bleeding from the gums and nose;
• increases the level of transaminases;
• intracranial bleeding;
• gastric bleeding, urogenital;
• fever;
• urticaria;
• bronchospasm;
• lowering blood pressure.

Drug interaction

Drug interaction Urokinase with drugs:

• Heparin, NSAIDs, Dipyridamole , - as a result of the interaction, the risk of bleeding increases;
• indirect anticoagulants and ASC in combination with this drug give "spontaneous" bleeding in the mediastinum;
• Epsilon-aminocaproic acid and tranexamic acid , when taken in conjunction with a drug, lead to a decrease in the activity of the latter.

Special patients and conditions

Clinical studies on the effects of Urokinase on the fetus during pregnancy and lactation have not been carried out, so there is not enough evidence on the safety of the use of the drug during this period.

To date, there is no precise information on the isolation of the active substance with breast milk during lactation, so when prescribing a therapy, breastfeeding should be discarded.

During the course of treatment, it is necessary to refuse the introduction of drugs intramuscularly and from the use of catheters with rigid cannulas.

Elderly patients are at increased risk of intracranial hemorrhage. It follows that the prescription of the preparation is necessary after assessing the risk and benefit for this category of people.

In the presence of a history of abnormalities in the liver and kidneys, a reduction in the doses of the drug is recommended. With such diseases, the level of fibrinogen should not fall below the level of 100 mg / dl.

Because clinical studies of the drug among children have not been carried out in full, it is forbidden to use Urokinase up to 18 years for patients under 18 years of age.

The effect of this drug on the ability to drive vehicles and other mechanisms is negligible.

Use this medication with extreme caution when:

• cerebrovascular disorder;
• mild hypertension;
• thrombosis of the left ventricle;
• mitral stenosis;
• atrial fibrillation;
• septic thrombophlebitis;
• older people over 70 years.

Practical experience of doctors and patients

On the use of the drug Urokinase from the words of doctors, as well as their patients.

Purchase and storage of medication

Depending on the dosage of the main drug component, the average price for Urokinase is between 790 and 11500 rubles.

The drug does not require special storage conditions. It is enough to keep the temperature not higher than 25 degrees Celsius and store the drug in a dark place away from children.

The drug is dispensed from pharmacies solely on prescription.

In the pharmacy, analogues are also available for sale, which, if necessary, can replace Urokinase:

• Ukidan;
• Purotsin.

There are also medicines that have the same effect:

• Biostream;
• Streptokinase;
• Acelisine;
• Celiaza;
• Indobufen;
• Streptodepression.