alteplase

Contraindication/Precautions

Contraindicated in:

• Active internal bleeding
• History of cerebrovascular accident (for MI and PE only)
• Recent (within 3 mo) intracranial or intraspinal injury or trauma
• Intracranial neoplasm, arteriovenous malformation, or aneurysm
• Known bleeding diathesis
• Severe uncontrolled hypertension (systolic BP >185 mmHg or diastolic BP >110 mmHg specifically for stroke indication)
• Evidence or suspicion of intracranial hemorrhage on pretreatment evaluation (for stroke indication only)
• Recent (within 3 mo) stroke (for stroke indication only)
• History of intracranial hemorrhage (for stroke indication only)
• Seizure at the onset of stroke (for stroke indication only)
• Current use of oral anticoagulants or an INR >1.7 or a prothrombin time >15 sec (for stroke indication only)
• Administration of heparin 48 hr before the onset of stroke with an elevated aPTT at presentation (for stroke indication only)
• Platelet count <100,000/mm³ (for stroke indication only)
• Hypersensitivity (for central venous access device occlusion indication only).

Use Cautiously in:

• Recent (within 10 days) major surgery, trauma, GI or GU bleeding
• Cerebrovascular disease
• Systolic BP ≥175 mmHg and/or diastolic BP ≥110 mmHg
• High likelihood of left heart thrombus
• Hemostatic defects
• Severe hepatic impairment
• Hemorrhagic ophthalmic conditions
• Septic thrombophlebitis
• Previous puncture of a noncompressible vessel
• Subacute bacterial endocarditis or acute pericarditis
• Severe neurological deficit (NIHSS >22) at presentation (for stroke indication only)
• Major early infarct signs on CT scan (for stroke indication only)
• Known or suspected infection in catheter (for central venous access device occlusion indication only)
• Geri: >75 yr; ↑ risk of intracranial bleeding
• OB: Lactation: Pedi: Safety not established.

Exercise Extreme Caution in:

Patients receiving concurrent anticoagulant therapy (↑ risk of intracranial bleeding).