Tissue Plasminogen Activator (tPA)

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This is known as thrombolytic therapy, useful for myocardial infarction and ischemic strokes, but contraindicated in hemorrhagic strokes (due to increased risk of bleeding).

[kaitiwalker]

Your videos are a great tool for comprehension and review! I'm a Perfusionist and I run the heart-lung machine for open heart surgery. Just wanted to let you know that open heart surgery is actually the correct term when referring to invasive cardiac surgery. A CABG is just one type of open heart surgery used to bypass occluded coronary vessels. We also do surgeries such as valve replacements/repairs, septal defect repairs, aneurysm repairs, aortic repairs/replacements (distal/abdominal aortic surgery is done by vascular teams), heart transplants, ventricular assist device implantation, among others. This does not include pediatric surgery which is far more complex and sometimes involves redirecting the path of blood flow in the cardio-pulmonary system.
Potential explanations of why heart surgery activates tPA is because of 1. damaged endothelium from incisions and suturing 2. contact activation. During heart surgery blood comes in contact with the disposable circuit tubing from the heart lung machine, the oxygenator, and with air in the reservoir which to blood is a foreign surface. Contact with these surfaces triggers SIRs (systemic Inflammatory response) and it activates clotting mechanisms. SIRs was discovered in the 1980s and we have been working ever since to prevent it. It can lead to DIC and other coagulopathies . One way we combat this is by anticoagulants such as heparin. Another is by coating our circuits with "bio-compatible" surface coating to prevent activation. Some centers will use anti-fibrinolytics like amicar in the circuit priming fluid as an additional precaution.

Thank you for your videos!!!

[rittenbrake]

"He who has a why to fibrinolysis can bear almost any mechanism" 😂👍🏻

[sathakamara]

You have explained this so well. I wish i watched your videos during my internship.

[trishag.]

I love your explanations! Your breakdown is easy to understand

[lisagevorkian]

you rock man! thank you and God bless you!

[CeliaHH]

It was great! Thank you very much! Many greetings from Germany!

[uxeoebn]

The antidote for plasmin in case of tPA toxicity is Aminocaproic acid. It inhibits proteolytic enzymes🌹

[lifesshortaname]

For the questions of the day, I’ll give it a try
1. Aminocaproic acid or transexamic acid are lysine analogs that bind to a site on plasminogen and block tPA from its action, preventing activation of plasminogen
2. Absolute contraindications to (r)tPA are major bleeds (recent or active or suspected) like intracranial hemorrhage, aneurisms/dissections, recent arterial puncture at non-compressible site.
Relative contraindications for use of thrombolytics are use of anticoagulants (below/above a threshold for plt count and INR, respectively), peptic ulcers, pregnancy, severe uncontrolled HTN, recent surgery (greater than 2-3 weeks prior), recent arterial puncture at compressible site, minor stroke

Just summarizing my notes; it’s not a definitive answer

[shang]

what other intravenous medication for the stroke except TPA please ?

[bobbybob]

Great video!
Why is t-PA realesed in hypoxia, acidosis, ADH, Catecholamine?

[Aismartin]

I have a AVM that bled a month ago. Will this help with quadrantanopia?

[Lady-Carmakazi]

Does anyone know what the safest brand or tpa name is ? I've heard the cheaper brands are more dangerous
Also how many times can we be given this medication in our life?

[TheKristanoelle]

This is the most hilarious video I’ve ever watched

[snehavimal]

😘 now I can solve all the question coagulation cascade

[ianrjm]

Many men suffer from Peyronie's Disease (plaque/fibrin in penis). Why does this fibrin remain and is not broken down? Will increased consumption of protease in theory help? Thank you for the great video.

[heathjardine]

7.45 Urokinase comes from or is produced by the kidney.

[arunaacharya]

3.11...Did u just say ..memorize this crap!😂😂

[drevon]

you talk very fast like someone running after you.