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Drug Interactions between heparin and Kinlytic

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

heparin urokinase

Applies to: heparin and Kinlytic (urokinase)

MONITOR CLOSELY: Although this combination is used therapeutically and recommended for certain indications (e.g., acute myocardial infarction, pulmonary embolism), fibrinolytic agents may enhance the anticoagulant effect of heparin. Data have shown that the partial thromboplastin time (PTT) may be significantly increased when fibrinogen concentrations fall in response to thrombolytic therapy. Large studies have reported that the risk of major bleeding is significantly higher when these drugs are given together. Hemorrhages have occurred during heparin infusion, one or more days after thrombolytic administration. Cholesterol embolization syndrome has also been reported rarely with thrombolytics and anticoagulants, when used alone or in combination.

MANAGEMENT: Alteplase is contraindicated in patients with acute ischemic stroke who have received heparin within the last 48 hours and have an elevated activated partial thromboplastin time (aPTT). Patients who are to receive a thrombolytic plus heparin for other indications should be carefully selected according to recommended eligibility criteria. The heparin dosage should be adjusted as appropriate to maintain therapeutic aPTT values. Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Thrombolytic and/or anticoagulation therapy should be discontinued immediately if serious or uncontrollable bleeding occurs.

References

  1. Gore JM, Sloan M, Price TR, Randall AM, Bovill E, Collen D, Forman S, Knatterud GL, Sopko G, Terrin ML (1991) "Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the Thrombolysis in Myocardial Infarction Study. Thrombolysis inMyocardial Infarction, Phase II, pilot and clinical trial." Circulation, 83, p. 448-59
  2. Sheiman RG, Phillips DA (1993) "Combined effects of urokinase and heparin on PTT values during thrombolytic therapy." Angiology, 44, p. 114-22
  3. Zahger D, Maaravi Y, Matzner Y, Gilon D, Gotsman MS, Weiss AT (1990) "Partial resistance to anticoagulation after streptokinase treatment for acute myocardial infarction." Am J Cardiol, 66, p. 28-30
  4. (2001) "Product Information. Abbokinase (urokinase)." Abbott Pharmaceutical
  5. (2001) "Product Information. Activase (alteplase)." Genentech
  6. (2001) "Product Information. Streptase (streptokinase)." Astra-Zeneca Pharmaceuticals
  7. Deboer A, Vangriensven JM (1995) "Drug interactions with thrombolytic agents: current perspectives." Clin Pharmacokinet, 28, p. 315-26
  8. Lam XM, Ward CA, Dumee CPRD (1995) "Stability and activity of alteplase with injectable drugs commonly used in cardiac therapy." Am J Health Syst Pharm, 52, p. 1904-9
  9. (2001) "Product Information. Retavase (reteplase)." Boehringer Mannheim
  10. (2001) "Product Information. TNKase (tenecteplase)." Genentech
  11. Harder S, Klinkhardt U (2000) "Thrombolytics: drug interactions of clinical significance." Drug Saf, 23, p. 391-9
  12. Hirsch J, Dalen J, Guyatt G, American College of Chest Physicians (2001) "The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Physicians." Chest, 119(1 Suppl), 1S-2S
View all 12 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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