Urokinase protocol

Keywords: urokinase protocol, urokinase directions dose
Description: Physician reviewed urokinase patient information - includes urokinase description, dosage and directions.

Urokinase is a man-made product developed using a protein that occurs naturally in the kidneys. Urokinase is a thrombolytic agent that works by dissolving blood clots.

FDA pregnancy category B. Urokinase is not expected to be harmful to an unborn baby. However, your doctor should know if you are pregnant before you receive this medication.

It is not known whether urokinase passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Urokinase is made from human kidney cells and albumin (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

Urokinase is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving urokinase.

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Avoid taking aspirin or ibuprofen (Motrin, Advil) to treat a fever shortly after you have received urokinase. These medications can increase your risk of bleeding. Ask your doctor about other methods of treating a fever.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Urokinase increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop. Bleeding may occur from a surgical incision, or from the skin where a needle was inserted during a blood test or while receiving injectable medication. You may also have bleeding on the inside of your body, such as in your stomach or intestines, kidneys or bladder, brain, or within the muscles.

easy bruising or bleeding (nosebleeds, bleeding gums, bleeding from a wound, incision, catheter, or needle injection);

sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure); or

pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Prior to beginning urokinase, a bolus of heparin 2500 to 10,000 units IV once should be given. Prior heparin administration should be considered when calculating the heparin dose.

1 to 2 million intl units administered IV once over 15 to 30 minutes. The rate of infusion is limited by side effects (fever, chills, rigors), and may need to be decreased in some patients. Doses up to 3 million intl units have been used to treat acute myocardial infarction (AMI).

To determine the response to urokinase, the manufacturer recommends serial angiography every 15 minutes. Maximal coronary artery opening usually occurs 15 to 30 minutes after opening begins.

Following the heparin bolus, urokinase may be infused into the occluded artery at a rate of 6000 intl units/min for up to 2 hours, with an average total dose of 500,000 intl units administered.

Alternatively, some studies have reported administering urokinase infusions at a rate of 20,000 to 25,000 intl units/min for 10 to 20 minutes up to a total dose of 250,000 to 500,000 intl units. It has not been established that intracoronary administration of urokinase during evolving transmural AMI results in salvage of myocardial tissue, nor that it reduces mortality.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

Maintenance: 4400 intl units/kg (IBW) /hour administered as a continuous IV infusion for 72 hours. Treatment may be needed for as long as 10 to 14 days in selected patients.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

When the following procedure is used for thrombolysis of a central venous catheter, the patient should be asked to hold his/her breath at end-exhalation any time the catheter is not connected to IV tubing, a heparin lock, or a syringe (to avoid air embolism).

Once a clot is suspected (after gentle aspiration of the affected catheter with a 10 mL syringe), 5000 intl units urokinase in a 1 mL tuberculin syringe may be slowly and gently injected, using only an amount equivalent to the volume of the catheter. A 5 or 10 mL syringe may be used to gently aspirate from the catheter every 5 minutes. If the catheter is not open within 30 minutes, the catheter may be capped allowing urokinase to dwell inside for 30 to 60 minutes before again attempting to aspirate. A second injection may be necessary in resistant cases.

Once patency is restored, aspiration and removal of 5 mL of blood is recommended to remove all drug and clot residual. Flushing the catheter with normal saline injection is then recommended.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with urokinase, especially:

NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or

medication used to prevent blood clots--dabigatran, dalteparin, desirudin, enoxaparin, fondaparinux, tinzaparin, warfarin, Coumadin.

This list is not complete. Other drugs may interact with urokinase, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

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