![]() The biggest drawback to this therapy is a patient delay in arriving at the emergency room or a delay in diagnosis. When used to treat acute MI, embolic stroke, and pulmonary embolism, the outcomes are fair to good. There have been many clinical trials undertaken to determine the effectiveness of thrombolytic agents in patients with acute myocardial infarction, pulmonary embolism, acutely ischemic limb, and an embolic stroke. Only through close communication and constant vigilance between the various healthcare professionals can the serious complications of these drugs be prevented. ![]() Plus, the pharmacist must be familiar with the recent novel anticoagulants and any possible interactions with the thrombolytic drugs. Also, the nurse should educate the patient about the procedure, the need to remain at bed rest for several hours after the procedure, and the need to constantly monitor for bleeding. For these agents to be effective, not only do they require administration within a certain timeframe, but one also has to ensure that the patient has no condition that contraindicates the therapy. There is no longer any question about the effectiveness of thrombolytic agents for the treatment of several medical disorders, but nurses, pharmacists, and radiologists must be fully aware of their indications and contraindications. The rapid conversion of plasminogen to plasmin signals a complement cascade leading to mast cell degranulation and subsequent anaphylactic reaction. See “streptokinase” for further discussion. Various sources of tPA have varying levels of antigenicity. Rates of adverse events, including bleeding, correlate to the total exposure of tPA.Ĭardiac dysrhythmias may occur when tPA is administered for NSTEMI and is related to the re-establishment of tissue perfusion rather than drug exposure.Īllergic reactions, including anaphylactic-type reactions, are possible following exposure to tPA. Studies indicate that the incidence of intracranial bleeding is dose-related, with the greatest percentage occurring at a dosage of 150 mg (1.3%) compared to 100 mg (0.4%). ![]() However, there was no increase in the incidence of 90-day mortality or severe disability in patients receiving alteplase. In clinical studies of adult patients with acute ischemic stroke (n = 624), a higher incidence of intracranial bleeding, especially symptomatic intracranial bleeding, was seen in patients receiving alteplase compared to placebo (total intracranial bleeding 15.4% versus 6.4%, p < 0.01 symptomatic intracranial bleeding 8% versus 1.3%, p < 0.01). Less serious spontaneous bleeding includes ecchymosis (1%), gingival bleeding (less than 1%), and epistaxis (less than 1%). Superficial or surface bleeding is observed mainly at invaded or disturbed sites such as venous cutdowns, arterial punctures, and recent surgical intervention sites. Internal bleeding includes intracranial bleeding (0.4% to 15.4%), retroperitoneal bleeding (less than 1%), gastrointestinal (GI) bleeding (5%), genitourinary bleeding (4%), and respiratory bleeding. īleeding associated with alteplase therapy can be divided into two broad categories. The most frequent serious adverse events associated with the administration of tPA are related to bleeding.
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