Administration of fibrinolytic therapy

The following general statements can be made about the practical aspects of thrombolytic therapy.

1. The 'younger' the thrombus, the greater is the likelihood of success.

2. Arterial clots are generally easier to lyse than venous clots.

3. Local infusion onto or into the clot is more effective.

4. Continuous rather than bolus therapy is more effective, but has a higher risk of systemic fibrinogenolysis and bleeding.

5. Adjunctive therapy is usually needed after successful thrombolysis.

6. Baseline prothrombin time, activated partial thromboplastin time, and thrombin time are indicated. Thrombin time should be checked 4 to 6 h after infusion, and the time should be prolonged by 1.5 to 5 times the baseline.

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