#ANTIDOTE FOR ALTEPLASE ACTIVATOR#

Binding of tissue plasminogen activator to cultured human endothelial cells. Activation of plasminogen by tissue plasminogen activator in normal and thrombasthenic platelets: effect of surface proteins and platelet aggregation. Thrombolysis in Myocardial Infarction (TIMI) Trial-Phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. Coronary thrombolysis with human single-chain, urokinase-type plasminogen activator (pro-urokinase) in patients with acute myocardial infarction. Treatment by bolus intravenous injection. Rapid lysis of coronary artery thrombosis with anisoylated plasminogen: streptokinase activator complex. Streptokinase: a review of its clinical pharmacology, mechanism of action, and therapeutic uses. We have developed an algorithm for using these products. Antifibrinolytic agents are available as a last alternative.

A target fibrinogen level of 1 g/L is desirable with cryoprecipitate infusion. Transfusion of cryoprecipitate, fresh frozen plasma, and platelets should be considered with clinical and laboratory reassessment after each administration. In the few patients who fail to respond to these conservative measures, judicious use of transfusion products may be indicated. Protamine should be considered if heparin has been administered within 4 hours of the onset of bleeding.

#ANTIDOTE FOR ALTEPLASE MANUAL#

Most patients who have bleeding can be managed by interruption of thrombolytic and anticoagulant therapy, volume replacement, and manual pressure applied to an incompetent vessel. Nevertheless, the role of platelet inhibition should be considered because many patients are treated with antiplatelet agents. Several in-vitro studies have shown plasmin-induced platelet dysfunction, but clinical data are limited. Although depletion of factors V and VIII may occur, the role of such depletion in bleeding is unknown. Hypofibrinogenemia and elevation of fibrinogen degradation products have been weakly correlated with the risk of hemorrhage. More than 70% of bleeding episodes occur at vascular puncture sites.

Hemorrhage is the major adverse effect of thrombolytic therapy, but its incidence can be reduced by careful selection of patients and avoidance of unnecessary invasive procedures.

Antidote for alteplase