Thrombolytic therapy is contraindicated in patients with a
systolic blood pressure greater than 185 mmHg or diastolic blood pressure greater than 110 mmHg
. Elevated blood pressure can lead to a delay in thrombolytic therapy, which is associated with increased morbidity.
What are the contraindications to thrombolytic therapy?
- Recent intracranial hemorrhage (ICH)
- Structural cerebral vascular lesion.
- Intracranial neoplasm.
- Ischemic stroke within three months.
- Possible aortic dissection.
- Active bleeding or bleeding diathesis (excluding menses)
Why thrombolytics are contraindicated in stroke?
Intravenous thrombolysis for stroke is contraindicated
if the patient is taking therapeutic doses of LMWH because of the presumed high risk of hemorrhagic complications
. Reports of IV thrombolysis given to patients taking LMWH are scarce in the literature.
When should you not give thrombolytics?
- A brain CT scan to make sure there has not been any bleeding.
- A physical exam that shows a significant stroke.
- Your medical history.
What is the most serious complication of thrombolytic therapy?
Intracranial hemorrhage
, the most devastating complication, occurs in 0.2-1% of patients treated with thrombolytic therapy. Factors associated with incremental risk are now being identified from large clinical trials.
What is the most common complication of fibrinolytic therapy?
The most feared complication of fibrinolysis is
intracranial hemorrhage (ICH)
, but serious hemorrhagic complications can occur from bleeding at any site in the body. Risk factors for hemorrhagic complications include the following: Increasing age. Lower body weight.
Why is streptokinase only given once?
As streptokinase is a bacterial product,
the body has the ability to build up an immunity to it
. Therefore, it is recommended that this medication should not be used again after four days from the first administration, as it may not be as effective and can also cause an allergic reaction.
What is the golden hour for stroke patients?
A door-to-treatment time
of 60 minutes or less
is the goal. This 60-minute period is often referred to as the “golden hour” of acute ischemic stroke treatment during which a focused diagnostic workup must be completed to rule out conditions that may mimic stroke as well as contraindications to rt-PA administration.
Why is tPA not given?
The drug tPA is able to bust up the clots to restore blood flow, thereby saving precious brain tissue. So why not give every stroke victim tPA? The reason is that
tPA is a powerful blood thinner
, and with that comes a risk of bleeding inside the brain.
What is the longest recommended time after a stroke that thrombolytics can be given?
Beyond
4.5 hours after onset
, no net benefit of therapy has been demonstrated. Current US and international consensus guidelines accordingly recommend intravenous thrombolysis when treatment can be initiated within 3 hours from stroke onset, the most well-established treatment timeframe.
What drug dissolves clots?
Anticoagulants
. Anticoagulants, such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban, are medications that thin the blood and help to dissolve blood clots.
Is fibrinolytic therapy as effective as Ppci?
Mechanical revascularization, or primary percutaneous coronary intervention (PPCI), of the infarct artery is the preferred method of restoring coronary perfusion because of its superior efficacy and decreased risk of complications compared with fibrinolytic therapy.
When should you not use alteplase?
- Intracranial hemorrhage.
- Subarachnoid hemorrhage.
- Internal bleeding.
- Stroke within the last three months.
- Intracranial or intraspinal surgery within the last three months.
What drugs are used in thrombolytic therapy?
- Eminase (anistreplase)
- Retavase (reteplase)
- Streptase (streptokinase, kabikinase)
- t-PA (class of drugs that includes Activase)
- TNKase (tenecteplase)
- Abbokinase, Kinlytic (rokinase)
What complications can occur for a client who receives tPA?
Complications related to intravenous r-tPA include
symptomatic intracranial hemorrhage, major systemic hemorrhage, and angioedema
in approximately 6%, 2%, and 5% of patients, respectively.
What is thrombolysis procedure?
Thrombolysis is
a procedure used to break up abnormal blood clots that restrict blood flow in veins and arteries
. We use two types of thrombolysis. For chemical thrombolysis we inject a medication, such as tissue plasminogen activator (tPA) or urokinase, through a catheter to dissolve the clot.
