Master Alteplase Antidote with Picmonic

Alteplase, a synthetic tissue plasminogen activator, functions as a fibrinolytic medication by converting plasminogen into enzyme plasmin. Plasmin breaks down blood clots by destroying fibrin structure, thereby dissolving the blood clot.

As a thrombolytic, alteplase breaks down an already-formed thrombus or blood clot and is used in acute situations. The formation of a blood clot within a blood vessel or within the heart may obstruct normal blood flow and tissue perfusion. The thrombus may result in acute myocardial infarction, acute ischemic stroke, or acute pulmonary embolism. In addition, this drug may be given to dissolve a thrombus causing central venous catheter (CVC) blockage. For acute ischemic stroke, treatment should be initiated promptly and no later than 4.5 hours after the onset of symptoms.

The most significant risk of alteplase therapy is bleeding, including intracranial hemorrhage, gastrointestinal bleeding, or any internal bleeding. Because alteplase activates plasminogen, it promotes fibrinolysis and can interfere with normal clotting, increasing the risk of bleeding complications.

Alteplase is contraindicated for patients with prior intracranial hemorrhage. Because of alteplase’s fibrinolytic activity, it may lead to life-threatening intracranial bleeding in patients with prior episodes of intracranial hemorrhage.

When active ongoing bleeding internal or external alteplase is contraindicated, as the drug may increase the risk of worsening the bleeding by promoting fibrinolysis.

Patients with a history of bleeding disorders, which involve conditions that impair blood clotting, are at increased risk of excessive bleeding, making the use of alteplase contraindicated due to its potential to worsen bleeding.

Since alteplase increases the risk of bleeding, precautions should be taken to avoid complications. Avoid administering anticoagulants (i.e., heparin, warfarin, dabigatran) and antiplatelet (i.e., aspirin, clopidogrel) medications since they increase the risk of bleeding. Maintain tissue integrity by avoiding invasive procedures and needle punctures related to subcutaneous or intramuscular injections.

Internal bleeding may cause hypovolemic shock in the patient receiving alteplase. Significant intravasculature fluid loss prevents the heart from pumping an adequate supply of blood and oxygen to the organs. It is important to frequently monitor the patient for symptoms of shock. Be alert for changing vital signs such as decreased blood pressure, increased heart rate, and decreased body temperature. Assess the patient for increasing anxiety, confusion, shallow breathing, profuse sweating, and weak pulse.

If excessive bleeding is suspected, stop thrombolytic therapy and administer aminocaproic acid (Amicar) as an antidote to prevent further bleeding. This antifibrinolytic drug prevents the conversion of plasminogen to plasmin and avoids fibrinolytic activity that results in bleeding.

Platelet transfusion is performed in alteplase toxicity only when bleeding is severe and platelet dysfunction or thrombocytopenia is present. It works to restore platelet numbers and functions to support clot formation.