Skip to main content

Pharmacokinetics and Pharmacodynamics of Fibrinolytic Agents

  • Chapter
Thrombolysis in Pulmonary Embolism

Abstract

In this chapter, the historical development, as well as, pharmacokinetics and pharmacological properties of the more frequently used fibrinolytic agents in pulmonary embolism patients, namely streptokinase, alteplase, and tenecteplase are analyzed. The historical development of the first-, second-, and third-generation fibrinolytics has been reviewed. Also, the first pulmonary embolism case using successful thrombolysis with streptokinase, rt-PA, alteplase, and TNK-t-PA is described.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Thelwell C. Biological standards for potency assignment to fibrinolytic agents used in thrombolytic therapy. Semin Thromb Hemost. 2014;40:205–13.

    Article  CAS  PubMed  Google Scholar 

  2. Furie F, Furie BC. Mechanisms of thrombus formation. N Engl J Med. 2008;359:938–49.

    Article  CAS  PubMed  Google Scholar 

  3. Silvain J, Collet JP, Nagaswami C, Beygui F, Edmondson KE, Bellemain-Appaix A, Cayla G, Pena A, Brugier D, Barthelemy O, Montalescot G, Weisel JW. Composition of coronary thrombus in acute myocardial infarction. J Am Coll Cardiol. 2011;57:1359–67.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Collen D. On the regulation and control of the fibrinolysis. Thromb Haemost. 1980;43:77–89.

    CAS  PubMed  Google Scholar 

  5. Tillet WS, Garner RL. The fibrinolytic activity of hemolytic streptococci. J Exp Med. 1933;58:485–502.

    Article  Google Scholar 

  6. Milstone H. A factor in normal human blood which participates in streptococcal fibrinolysis. J Immunol. 1941;42:109–16.

    CAS  Google Scholar 

  7. Christensen LR. Streptococcal fibrinolysis: a proteolytic reaction due to a serum enzyme activated by streptococcal fibrinolysis. J Gen Physiol. 1945;28:363–83.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Christensen LR, MacCleod CM. A proteolytic enzyme of serum: characterization, activation and reaction with inhibitors. J Gen Physiol. 1945;28:559–83.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Tillet WS, Sherry S. The effect of streptococcal fibrinolysis (streptokinase) and streptococcal deoxyribonuclease on fibrinous, purulent and sanguinous pleural exudation. J Clin Invest. 1949;28:173–90.

    Article  Google Scholar 

  10. Johnson AJ, McCarthy WR. The lysis of artificially induced clots in man by intravenous of streptokinase. J Clin Invest. 1957;38:1627–43.

    Article  Google Scholar 

  11. Kline DL. Purification and crystallization of plasminogen (profibrinolysin). J Biol Chem. 1953;2404:949–55.

    Google Scholar 

  12. Sherry S. The fibrinolytic activity of streptokinase activated human plasmin. J Clin Invest. 1954;35:1054–63.

    Article  Google Scholar 

  13. Sherry S, Fletcher AP, Alkjaersig N, Smyrniotis FE. An approach of intravascular fibrinolysis in the man. Trans Assoc Am Physicians. 1957;70:288–96.

    CAS  PubMed  Google Scholar 

  14. Fletcher AP, Alkjaersig N, Smyrniotis FE, Sherry S. The treatment of patients suffering from early myocardial infarction with massive and prolonged streptokinase therapy. Trans Assoc Am Physicians. 1958;71:287–96.

    CAS  PubMed  Google Scholar 

  15. Fletcher AP, Alkjaersig N, Sherry S. The maintenance of a sustained thrombolytic state in man. I. Induction and effects. J Clin Invest. 1959;38:1096–110.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Fletcher AP, Sherry S, Alkjaersig N, Smyrniotis FE, Jick S. Clinical observations on patients with myocardial infarction and other thromboembolic disorders. J Clin Invest. 1959;38:1111–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Bett JHN, Castaldi PA, Hale GS, Ibist JP, Mclean KH, O´Sullivan EF, Biggs JC, Chesterman CN, Hirsh J, Mcdonald IG, Morgan JJ, Rosembaum M. Australian multicenter trial of streptokinase in acute myocardial infarction. Med J Aust. 1977;1:553–60.

    Google Scholar 

  18. Jerjes-Sanchez C, Ramirez-Rivera A, Elizalde GJ, Delgado R, Cicero R, Ibarra-Perez C, Arroliga AC, Padua A, Portales A, Villarreal A, Perez-Romo A. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema. A multicenter trial. Chest. 1996;109:1514–9.

    Article  CAS  PubMed  Google Scholar 

  19. Browse NL, James DCO. Streptokinase in pulmonary embolism. Lancet. 1964;2:1039–43.

    Article  CAS  PubMed  Google Scholar 

  20. Sikri N, Bardia A. A history of streptokinase use in acute myocardial infarction. Tex Heart Inst J. 2007;34:318–27.

    PubMed Central  PubMed  Google Scholar 

  21. Longstaf C, Thelwell C, Whitton C. The poor quality of streptokinase products in use in developing countries. Thromb Haemost. 2005;3:1092–3.

    Article  Google Scholar 

  22. Jerjes-Sanchez C, Ramirez-Rivera A, Garcia ML, Arriaga-Nava R, Valencia-Sanchez S, Rosado-Buzzo A, Pierzo JA, Rosas ME. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis. 1995;2:67–9.

    Article  Google Scholar 

  23. Astrup T, Permim PM. Fibrinolysis in the animal organism. Nature. 1947;159:681–2.

    Article  CAS  PubMed  Google Scholar 

  24. Astrup T, Stage A. Isolation of a soluble fibrinolytic activator from animal tissue. Nature. 1952;170:929.

    Article  CAS  PubMed  Google Scholar 

  25. Collen D. Identification and some properties of a new fast-reacting plasmin inhibitor in human plasma. Eur J Biochem. 1976;69:209–16.

    Article  CAS  PubMed  Google Scholar 

  26. Collen D, Lijnen HR. History of discovery: the tissue-type plasminogen activator story. Arterioscler Thromb Vasc Biol. 2009;29:1151–5.

    Article  CAS  PubMed  Google Scholar 

  27. Rijken DC, Wijngaards G, Zaal-de Jong M, Welbergen J. Purification and partial characterization of plasminogen activator from human uterine tissue. Biochim Biophys Acta. 1979;580:140–53.

    Article  CAS  PubMed  Google Scholar 

  28. Rijken DC, Wijngaards G, Welbergen J. Relationship between tissue plasminogen activator and the activators in blood and vascular wall. Thromb Res. 1980;18:815–30.

    Article  CAS  PubMed  Google Scholar 

  29. Rijken DC, Collen D. Purification and characterization of the plasminogen activator secreted by human melanoma cells in culture. J Biol Chem. 1981;256:7035–41.

    CAS  PubMed  Google Scholar 

  30. Hoylaerts M, Rijken DC, Lijnen HR, Collen D. Kinetics of the activation of plasminogen by human tissue plasminogen activator. Role of fibrin. J Biol Chem. 1982;257:2912–9.

    CAS  PubMed  Google Scholar 

  31. Rijken DC, Juhan-Vague I, De Cock F, Collen D. Measurement of human tissue-type plasminogen activator by a two-site immunoradiometric assay. J Lab Clin Med. 1983;101:274–84.

    CAS  PubMed  Google Scholar 

  32. Collen D, Rijken DC, Van Damme J, Billiau A. Purification of human extrinsic (tissue-type) plasminogen activator in centigram quantities from a human melanoma cell culture fluid and its conditioning for use in vivo. Thromb Haemost. 1982;48:294–6.

    CAS  PubMed  Google Scholar 

  33. Matsuo O, Rijiken DC, Collen D. Thrombolysis by human tissue plasminogen activator and urokinase in rabbits with experimental pulmonary embolism. Nature. 1981;291:590.

    Article  CAS  PubMed  Google Scholar 

  34. Bergman SR, Fox KAA, Ter-Pogossian MM, Sobel BE, Collen D. Clot-selective coronary thrombolysis with tissue-type plasminogen activator. Science. 1983;220:1181.1183.

    Article  Google Scholar 

  35. Van de Werf F, Ludbrook PA, Bergmann SR, Tiefenbrunn AJ, Fox KAA, DeGeest H, Verstraete M, Collen D, Sobel BE. Coronary thrombolysis with tissue-type plasminogen activator in patients with evolving myocardial infarction. N Engl J Med. 1984;310:609–13.

    Article  PubMed  Google Scholar 

  36. Bounameaux H, Vermylen H, Collen D. Thrombolytic treatment with recombinant tissue-type recombinant activator in a patient with massive pulmonary embolism. Ann Intern Med. 1985;103:64–5.

    Article  CAS  PubMed  Google Scholar 

  37. Binder BR, Spragg J, Austen KF. Purification and characterization of human vascular plasminogen activator derived from blood vessels perfusates. J Biol Chem. 1979;254:1998–2003.

    CAS  PubMed  Google Scholar 

  38. Korninger C, Collen D. Neutralization extrinsic (tissue-type) plasminogen activator in human plasma: no evidence for a specific inhibitor. Thromb Haemost. 1981;46:662–5.

    CAS  PubMed  Google Scholar 

  39. Ranby M, Bergsdorf N, Nilsson T. Enzymatic properties of one-chain and two-chain forms of tissue plasminogen activator. Thromb Res. 1982;27:175–83.

    Article  CAS  PubMed  Google Scholar 

  40. Ranby M, Bergsdorf N, Pohl G, Wallen P. Isolation of two variants of native one-chain tissue plasminogen activator. FEBS Lett. 1982;146:289–92.

    Article  CAS  PubMed  Google Scholar 

  41. Thorsen S, Glas-Greenwalt P, Astrup T. Differences in the binding of fibrin to urokinase and tissue plasminogen activator. Thromb Diath Haemorrh. 1972;28:65–74.

    CAS  PubMed  Google Scholar 

  42. Rijken DC, Hoylaerts M, Collen D. Fibrinolytic properties of one-chain and two-chain human extrinsic (tissue-type) plasminogen activator. J Biol Chem. 1982;257:2920–5.

    CAS  PubMed  Google Scholar 

  43. Camiolo SM, Thorsen D, Astrup T. Fibrinogenolysis and fibrinolysis with tissue plasminogen activator, urokinase, streptokinase-activated human globulin, and plasmin. Proc Soc Exp Biol Med. 1971;138:277–80.

    Article  CAS  PubMed  Google Scholar 

  44. Wallen P. Thrombosis and urokinase. In: Paoletti R, Sherry S, editors. Activation of plasminogen with urokinase and tissue activator. London: Academic; 1977. p. 91–102.

    Google Scholar 

  45. Ranby M. Studies on the kinetics of plasminogen activation by tissue plasminogen activator. Biochim Biophys Acta. 1982;704:461–9.

    Article  CAS  PubMed  Google Scholar 

  46. Nieuwenhuizen W, Verheijen JH, Vermond A, Chang GTG. Plasminogen activation by tissue activator is accelerated in the presence of fibrin(ogen) cyanogen bromide fragment FCB-2. Biochim Biophys Acta. 1983;775:531–3.

    Article  Google Scholar 

  47. Nieuwenhuizen W, Vermond A, Voskuilen M, Traas DW. Identification of the site in fibrin(ogen) which is involved in the acceleration of plasminogen activation by tissue-type plasminogen activator. Biochim Biophys Acta. 1983;748:86–92.

    Article  CAS  PubMed  Google Scholar 

  48. Radcliffe R, Heinze T. Stimulation of tissue plasminogen activator by denatured proteins and fibrin clot: a possible additional role for plasminogen activator. Arch Biochem Biophys. 1981;211:750–61.

    Article  CAS  PubMed  Google Scholar 

  49. Suenson E, Lützen O, Thorsen S. Initial plasmin-degradation of fibrin as the basis of a positive feedback mechanism in fibrinolysis. Eur J Biochem. 1984;140:513–22.

    Article  CAS  PubMed  Google Scholar 

  50. Lijnen HR, Hoylaerts M, Collen D. Isolation and characterization of human plasma protein with affinity for the lysine-binding site of plasminogen. Role in the regulation of fibrinolysis and identification as histine-rich glycoprotein. J Biol Chem. 1980;255:10214–22.

    CAS  PubMed  Google Scholar 

  51. Holvoet P, Lijnen HR, Collen D. Characterization of functional domains in human tissue-type plasminogen activator with the use of monoclonal antibodies. Eur J Biochem. 1986;158:173–7.

    Article  CAS  PubMed  Google Scholar 

  52. Rijken DC, Groeneveld E. Isolation and functional characterization of the heavy and light chains of human tissue-type plasminogen activator. J Biol Chem. 1986;261:3098–102.

    CAS  PubMed  Google Scholar 

  53. Wiman B, Collen D. On the kinetics of the reaction between human antiplasmin and plasmin. Eur J Biochem. 1978;84:573–8.

    Article  CAS  PubMed  Google Scholar 

  54. Van de Werf FJ. The ideal fibrinolytic: can drug design improve clinical results? Eur Heart J. 1999;20:1452–8.

    Article  PubMed  Google Scholar 

  55. Jerjes-Sánchez C, Gutiérrez-Fajardo P, Ramírez-Rivera A, García ML, Hernández CHG. Acute right ventricular myocardial infarction secondary to massive pulmonary embolism. Arch Inst Cardiol Mex. 1995;65:65–73.

    PubMed  Google Scholar 

  56. Tanswell P, Modi N, Combs D, Danays T. Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy for acute myocardial infarction. Clin Pharmacokinet. 2002;41:1229–45.

    Article  CAS  PubMed  Google Scholar 

  57. Goldhaber SZ, Come PC, Lee RT, Brauwald LT, Parker JA, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, de Silva AM T, Mogtader A, McDonough TJ. Alteplase versus heparin in acute pulmonary embolism; randomized trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993;341:507–11.

    Article  CAS  PubMed  Google Scholar 

  58. Keyt B, Paoni NF, Refino CJ, et al. A faster-acting and more potent form of tissue plasminogen activator. Proc Natl Acad Sci U S A. 1994;91:3670–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Benedict CR, Refino CJ, Keyt BA, et al. New variant of human tissue plasminogen activator (TPA) with enhanced efficacy and lower incidence of bleeding compared with recombinant human TAP. Circulation. 1995;92:3032–40.

    Article  CAS  PubMed  Google Scholar 

  60. Cannon CP, McCabe CH, Gibson CM, et al. and the TIMI 10A Investigators. TNK-tissue plasminogen activator in acute myocardial infarction. Results of the Thrombolysis in Myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) 10A Dose-Rangin Trial. Circulation 1997;95:351–6.

    Google Scholar 

  61. Modi NB, Eppler S, Breed J, Cannon CP, Braunwald E, Love TW. Pharmacokinetics of a slower clearing tissue plasminogen activator variant, TNK-tPA, in patients with acute myocardial infarction. Thromb Haemost. 1998;79:134–9.

    CAS  PubMed  Google Scholar 

  62. DeMarco E, Rebuzzi AG, Quaranta G, et al. Lack of procoagulant effect after TNK-plasminogen activator in patients with acute myocardial infarction. Eur Heart J. 1998;19(Abstr Suppl):563.

    Google Scholar 

  63. Cannon CP, Gibson CM, McCabe CH, et al. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction. Results of the TIMI 10B trial. Circulation. 1998;98:2805–14.

    Article  CAS  PubMed  Google Scholar 

  64. Caldicott D, Parasivam S, Harding J, Edwards N, Bochner F. Tenecteplase for massive pulmonary embolus. Resuscitation. 2002;55:2011–3.

    Article  Google Scholar 

  65. Sze DY, Carey MBL, Razavi MK. Treatment of massive pulmonary embolus with catheter-directed tenecteplase. J Vasc Interv Radiol. 2001;12:1456–7.

    Article  CAS  PubMed  Google Scholar 

  66. Noorman F, Rijken DC. Regulation of tissue-type plasminogen activator concentrations by clearance via the mannose receptor and other receptors. Fibrinol Proteol. 1997;11:173–86.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C. .

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Jerjes-Sánchez, C., Rodriguez, H.D. (2015). Pharmacokinetics and Pharmacodynamics of Fibrinolytic Agents. In: Thrombolysis in Pulmonary Embolism. Springer, Cham. https://doi.org/10.1007/978-3-319-19707-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19707-4_2

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19706-7

  • Online ISBN: 978-3-319-19707-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics