Tissue Plasminogen Activator

Clinical indications for thrombolysis in treatment of pulmonary embolism, acute ischemic stroke, acute MI, and occluded central venous access devices.

• MI: Administration as soon as possible from symptom onset

• Stroke: Administration within 3 h from onset of symptoms

Rapid clot lysis by t-PA offers advantages in comparison with streptokinase.

May be used in combination with other anticoagulants such as heparin and aspirin. Also may be combined with beta-blockers, morphine, nitroglycerin, and plt IIb/IIIa blockers.

Increased risk of bleeding during surgery; if severe, possible need for blood transfusion, fresh frozen plasma, cryoprecipitate, and plt infusion therapy.

Strict blood pressure monitoring with intraop Htn posing increased risk of intracranial hemorrhage (0.8% with acute MI therapy and 6% with acute ischemic stroke therapy).

Incomplete restoration of coronary blood flow and persisting thrombogenicity may lead to cardiac instability and risk for periop infarction.