Alteplase precautions

List of precautions
Monitor bleeding Pregnancy Lactation Children Hypersensitivity 50 mg vial Acute ischemic stroke Acute MI Administration Cholesterol embolism Infection Pulmonary embolism Warfarin Patient Information

Monitor bleeding
Most frequent and serious adverse reaction. Monitor patient for signs of internal and superficial bleeding throughout therapy, paying particular attention to recent puncture and cutdown sites. If bleeding develops (epistaxis, hematuria, hematemesis, bloody or black, tarry stools) notify health care provider immediately. Should uncontrollable bleeding occur, discontinue alteplase therapy and concurrent heparin. Be prepared to administer protamine to reverse heparin effects.

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Pregnancy
Category C.

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Lactation
Undetermined.

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Children
Safety and efficacy not established (Activase); safety and efficacy in children younger than 2 yr of age or who weigh less than 10 kg have not been established (Cathflo Activase).

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Hypersensitivity
There is no experience with readministration of alteplase.

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50 mg vial
Do not use 50 mg vial if vacuum is not present.

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Acute ischemic stroke
Risk of alteplase therapy to treat acute ischemic stroke may be increased by severe neurological deficit at presentation and major early infarct on a CT scan and should be weighed against the benefit.

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Acute MI
In patients who are at low risk of death from cardiac causes and who have high BP at time of presentation, risk of stroke may offset survival benefit produced by thrombolytic therapy.

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Administration
Avoid IM injections, noncompressible arterial punctures, internal jugular and subclavian venous punctures, and nonessential handling of patient during treatment. Perform venipunctures carefully and as infrequently as possible during therapy.

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Cholesterol embolism
May occur rarely in patients treated with thrombolytic agents.

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Infection
Use with caution in presence of known or suspected infection in a catheter because use may release a localized infection into the systemic circulation.

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Pulmonary embolism
Alteplase does not constitute treatment of underlying deep vein thrombosis; therefore, consider the risk of re-embolism caused by lysis of underlying deep vein thrombi.

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Warfarin
Do not administer alteplase if patient is on warfarin and INR is greater than 1.7 or PT is greater than 15 sec; if heparin had been administered within 48 h preceding stroke onset and aPTT was elevated at time of presentation.

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Patient Information

 * Advise patient, family, or caregiver that medication will be prepared and administered by a health care professional in a medical setting.
 * Instruct patient, family, or caregiver to report any unusual symptoms or feelings, signs of bleeding, or allergic reaction immediately.
 * Caution patient to avoid getting out of bed without assistance during treatment.

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