| Streptokinase | Urokinase | Alteplase | Reteplase | Tenecteplase | |
|---|---|---|---|---|---|
| activate systemic plasminogen, which is not part of the clot matrix hydrolyses fibrin of thromboemboli, causing clot lysis | preferentially activate plasminogen on clot surface. Classified as fibrin specific |
||||
| Generation | 1st | 1st | 2nd | 3rd | 3rd |
| Clot-specific? | No | No | Yes | Yes | Yes |
| Half-life (mins) | 12 | 7–20 | 4–10 | 11–19 | 15–24 |
if no obvious cause of embolic disease is found, hypercoagulation investigation should follow:
| Wells criteria for PE | |
|---|---|
| clinical signs and symptoms of DVT | 3 |
| alternative diagnosis is less likely than PE | 3 |
| HR >100 | 1.5 |
| immobilisation ≥3 consecutive days or surgery in the previous 4/52 | 1.5 |
| previous objectively diagnosed PE or DVT | 1.5 |
| haemoptysis | 1 |
| malignancy (on Rx, or in last 6/12 or palliative) | 1 |
| 0-1: low risk 2-6: moderate risk >6: high risk |
|
| Age | Age in years |
|---|---|
| Male sex | 10 |
| Cancer | 30 |
| Heart Failure | 10 |
| Chronic lung disease | 10 |
| Pulse ≥ 110/min | 20 |
| sBP < 100 mm Hg | 30 |
| RR ≥ 30/min | 20 |
| Temperature < 36°C | 20 |
| Altered mental status | 60 |
| PaO2 sat < 90% (+/-O2 Rx) | 20 |
| score | ||
|---|---|---|
| ≤ 65 | Class I, Very Low Risk | discharge on oral anti-coag |
| 66-85 | Class II, Low Risk | discharge on oral anti-coag |
| 86-105 | Class III, Intermediate Risk | potential for decompensation probable admission for Ix and monitoring |
| 106-125 | Class IV, High Risk | admission |
| > 125 | Class V, Very High Risk | admission |