Urokinase Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Myocardial Infarction

Lysis of coronary artery thrombi:
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.

Systemic thrombolytic administration:
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.

Direct intracoronary artery infusion:
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.

Usual Adult Dose for Pulmonary Embolism

Initial: 4400 intl units/kg ideal body weight (IBW) administered as an IV bolus over 10 minutes.

Maintenance: 4400 intl units/kg (IBW) /hour administered as a continuous IV infusion for 12 hours.

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

Usual Adult Dose for Deep Vein Thrombosis

Initial: 4400 intl units/kg ideal body weight (IBW) administered as an IV bolus over 10 minutes.

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.

Usual Adult Dose for Thrombotic/Thromboembolic Disorder

IV catheter clearance:
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.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Urokinase is contraindicated in the presence of active internal bleeding; a history of cerebrovascular accident; intracranial or intraspinal surgery or trauma within the past two months; intracranial neoplasm, arteriovenous malformation or aneurysm; severe, uncontrolled hypertension, or a known bleeding diathesis.

Dialysis

Data not available

Other Comments

Although urokinase has not been extensively studied in the treatment of ischemic stroke, according to AHA/ASA guidelines for the early management of ischemic stroke, use of a thrombolytic agent (i.e., recombinant tissue plasminogen activator; alteplase) within 3 hours of stroke symptom onset is associated with improved outcomes. Earlier treatment (i.e., within 90 minutes) may be more likely to result in a favorable outcome. However, the upper limit of the treatment window may be as late as 5 to 6 hours after symptom onset.

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