Urokinase

How it works

It directly converts plasminogen to plasmin, which degrades fibrin within the thrombus and so promotes clot lysis.

Prescribing in practice

• Bleeding is the principal hazard; it is contraindicated where there is active internal bleeding, recent surgery or trauma, or a high risk of intracranial haemorrhage.
• Concurrent anticoagulants or antiplatelet agents substantially increase the risk of serious haemorrhage.
• Use should be confined to settings with facilities to manage bleeding complications and to monitor the patient closely.

Monitoring

Monitor for signs of bleeding and haemodynamic instability throughout treatment, with relevant coagulation parameters as indicated by the clinical situation.

Counselling the patient

• Tell the team at once about any unusual bleeding, bruising, or blood in the urine or stool.
• Avoid unnecessary injections and procedures during treatment to reduce bleeding risk.
• Treatment is given and supervised in a closely monitored clinical setting.

Evidence & guidelines

Use of fibrinolytic agents such as urokinase is guided by established thrombolysis principles and the relevant product information.