<unk>  is mainly used to treat acute ischemic stroke, acute myocardial infarction, acute massive pulmonary embolism, and blocked catheters. Similar to other thrombolytic drugs,<unk>  is used to dissolve clots to restore tissue perfusion, but this can vary depending on the pathology. Generally,<unk>  is delivered intravenously into the body. To treat blocked catheters,<unk>  is administered directly into the catheter.<unk>  has also been used off-label for deep vein thrombosis, peripheral artery disease, pleural effusion in children, prosthetic valve thrombosis, frostbite, and peritonitis. Ischemic stroke In adults diagnosed with acute ischemic stroke, thrombolytic treatment with<unk>  is the standard of care during early management (within 4.5 hours of symptom onset). When mechanical thrombectomy is not available,<unk>  may be considered up to 9 hours after symptom onset. Administration of<unk>  is associated with improved functional outcomes and reduced incidence of disability.<unk>  used in conjunction with mechanical thrombectomy is associated with better outcomes. Use is restricted, however, if there is a risk of major bleeding or if there may be another cause of stroke symptoms.<unk>  is not recommended for those with non-disabling stroke. For patients with early recurrent ischemic stroke, repeated use of<unk>  may be safe and efficacious.<unk>  is also commonly used in children, though guidelines are not yet standardized as they are for adults. Myocardial infarction Currently, the preferred treatment for ST-elevation myocardial infarction (STEMI) is percutaneous coronary intervention (PCI). However, PCI is only available at 25% of hospitals in the United States;<unk>  is recommended if the patient is at a non-PCI capable hospital and cannot be transferred to receive PCI in under 120 minutes.<unk>  can also be used before arriving at the hospital if transportation time is anticipated to be greater than 30 minutes.<unk>  may be used in conjunction with aspirin and heparin. An accelerated infusion of<unk>  was found to significantly reduce mortality in comparison to a non-accelerated infusion, though it also slightly increases the risk of major bleeding.<unk>  should not be used in cases of acute coronary syndrome other than STEMI. Pulmonary embolism As of 2019,<unk>  is the most commonly used medication to treat pulmonary embolism (PE).<unk>  has a short infusion time of 2 hours and a half-life of 4–6 minutes.<unk>  has been approved by the FDA, and treatment can be done via systemic thrombolysis or catheter-directed thrombolysis. Systemic thrombolysis can quickly restore right ventricular function, heart rate, and blood pressure in patients with acute PE. However, standard doses of<unk>  used in systemic thrombolysis may lead to massive bleeding, such as intracranial hemorrhage, particularly in older patients. A systematic review has shown that that low-dose<unk>  is safer than and as effective as the standard amount. Catheter-directed thrombolysis may be more efficient than systemic thrombolysis, as<unk>  is locally administered to the occlusion site, and wash-away of the medication into other blood vessels is minimized. This procedure involves positioning a multi-sidehole catheter into the blood clot.<unk>  may be used to treat PE if patients have a high risk for complications, such as if: * they are hypotensive with a systolic blood pressure less than 90 mmHg * they are in cardiac arrest presumed to be caused by a pulmonary embolism * their clinical exam shows signs of deterioration or worsening of symptoms Blocked catheters<unk>  can be used in small doses to clear blood clots that obstruct a catheter, reopening the catheter so it can continue to be used. Catheter obstruction is commonly observed with a central venous catheter. Currently, the standard treatment for catheter obstructions in the United States is<unk>  administration.<unk>  is effective and low risk for treating blocked catheters in adults and children. Overall, adverse effects of<unk>  for clearing blood clots are rare. Novel alternatives to treat catheter occlusion, such as tenecteplase, reteplase, and recombinant urokinase, offer the advantage of shorter dwell times than<unk> .
Alteplase
Tenecteplase
Desmoteplase
Argatroban
Prasugrel
Rivaroxaban
Ticagrelor
Lusutrombopag