Alteplase Side Effects
More frequently reported side effects include: gastrointestinal hemorrhage and genitourinary tract hemorrhage. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to alteplase: intravenous powder for solution
In addition to its needed effects, some unwanted effects may be caused by alteplase. In the event that any of these side effects do occur, they may require medical attention.
If any of the following side effects occur while taking alteplase, check with your doctor or nurse immediately:More common:
- Bleeding from puncture sites and wounds
- bleeding gums
- coughing up blood
- difficulty with breathing or swallowing
- increased menstrual flow or vaginal bleeding
- prolonged bleeding from cuts
- red or black, tarry stools
- red or dark brown urine
- fast heartbeat
- pain in the chest, groin, or legs, especially the calves
- pain, redness, or swelling in the arm or leg
- rapid, shallow breathing
- severe, sudden headache
- slurred speech
- sudden loss of coordination
- sudden, severe weakness or numbness in the arm or leg
- sudden, unexplained shortness of breath
- vision changes
- blue lips and fingernails
- blue or pale skin
- blurred vision
- chest pain or discomfort
- chest pain, possibly moving to the left arm, neck, or shoulder
- cool, sweaty skin
- coughing that sometimes produces a pink frothy sputum
- decreased urine output
- dilated neck veins
- extreme fatigue
- hives or welts, itching, or skin rash
- increased sweating
- large, hive-like swelling on the mouth, lips, or tongue
- loss of bladder control
- muscle spasm or jerking of all extremities
- nausea or vomiting
- pain or discomfort in the arms, jaw, back, or neck
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- redness of the skin
- slow or irregular breathing or heartbeat
- sudden loss of consciousness
- swelling of the face, fingers, feet, lower legs, or ankles
- unusual tiredness or weakness
- weight gain
For Healthcare Professionals
Applies to alteplase: injectable powder for injection, intravenous powder for injection
The incidence of major hemorrhagic events among heparinized patients with acute myocardial infarction who underwent cardiac catheterization in the Thrombolysis in Myocardial Infarction (TIMI) study significantly increased with age, averaging 8.7% and 24.7% for patients less than 65 years and 70 to 76 years old, respectively. These values agree with GISSI-2 data, where the overall incidence of bleeding associated with alteplase with and without heparin was 8.5% (0.5% major, 8.0% minor). Concomitant administration of heparin did not increase the incidence of stroke, although the incidence of major bleeding was greater in patients who received both thrombolytic (alteplase or streptokinase) and heparin therapy.
In one large study of 139 patients with acute thrombotic or embolic stroke, the incidence of hemorrhagic infarction averaged 20.2%. Parenchymal hematoma was observed in 10.6% of patients in this study, and neurological worsening accompanied by either hemorrhagic infarction or brain parenchymal hematoma was observed in 9.6% of patients. Limited data in which 100 mg of alteplase was given to 32 patients with documented middle cerebral artery and/or intracranial internal carotid artery occlusion reveal an incidence of hemorrhagic infarction without clinical deterioration in 28%, fatal parenchymal hemorrhage in 9%, and serious puncture site hemorrhage in 6% of patients.
In general, the overall incidence of alteplase-induced symptomatic intracerebral hemorrhage (ICH) in most studies has ranged between 3% and 7%. It appears that the overall risk of symptomatic ICH with the use of IV alteplase therapy is dependent on the expertise of the treating clinician. In one report, the risk of symptomatic ICH was 4% if protocol guidelines were strictly followed, but more than 10% when deviating from protocol guidelines. Other studies have confirmed these findings. The risk of ICH appears to be higher in elderly patients treated with thrombolytics for acute MI. An alternative reperfusion strategy (i.e., angioplasty) may be considered in this patient population.[Ref]
The hematologic side effect, bleeding, is the most common adverse event in all approved indications.
The incidence of bleeding among patients with acute myocardial infarction who received alteplase (often with aspirin and heparin) ranged from 8% to 77% (0.5% to 10% serious). Blood loss of greater than 250 mL occurred in up to 5% of patients, and typically affected the gastrointestinal tract (5%) or genitourinary tract (4%). Ecchymosis, epistaxis, gingival, or retroperitoneal bleeding occurred in up to 1% of patients.
The incidence of alteplase-associated intracranial hemorrhagic (ICH) in patients with acute myocardial infarction is dose-related and has averaged about 1%. Administration of 100 mg over 3 hours resulted in an incidence of stroke of 0.4%, at 100 mg over 90 minutes the rate was 0.7%, and at 150 mg over 90 minutes the rate of ICH was 1.3%. ICH in patients with acute ischemic stroke was significantly greater in patients receiving alteplase (15.4%) compared to placebo (6.4%). Symptomatic ICH (defined as sudden clinical worsening followed by subsequent CT verification of ICH) occurred in 8% (6.4% within 36 hours of receiving alteplase).
Stroke occurred in 1.2% to 1.6% of patients experiencing an AMI and receiving alteplase as a 3 hour infusion or an accelerated infusion, respectively.
Rare cases of atheroembolic events have been associated with the use of this drug and other lytic agents.
If bleeding occurs during therapy with alteplase and cannot be controlled by pressure, it is recommended that alteplase (and heparin, if applicable) should be discontinued immediately. Arterial punctures are of particular concern and an upper extremity accessible to manual compression is preferred. The usual precautions and procedures following arterial catheterization are extremely important. It is recommended that other invasive procedures be avoided or minimized. Non-compressible venous sites should be avoided.[Ref]
Cardiovascular-related side effects may occur more frequently in patient with an acute myocardial infarction (AMI) or pulmonary embolism. These events may be a sequelae of the disease and their relationship to the drug is not always clear. Reperfusion arrhythmias, including sinus bradycardia, accelerated idioventricular rhythm, premature ventricular depolarizations, or ventricular tachycardia commonly have occurred. Alteplase has been shown to significantly reduce the incidence of in-hospital mortality, left ventricular failure, postinfarction angina, reinfarction, and all ischemic events in patients with AMI.
Alteplase-associated cases of recurrent thrombosis or reinfarction have been reported. Rarely, reinfarction may be due to embolization of partially lysed thrombi. Reformation of thrombi may be due to elevated thrombin-antithrombin-III levels during alteplase therapy. Theoretically, adjunctive therapy with continuous heparin will significantly decrease the risk of an alteplase-induced hypercoagulable state.
Angioedema has also been reported (1% to 2%) during alteplase therapy in patients with acute ischemic stroke, particularly when alteplase was used in combination with an angiotensin-converting enzyme inhibitor. Orolingual angioedema has, in most cases, been mild, transient, and spontaneously reversible; however, it can be rapidly progressive requiring urgent intubation.
Recurrent hemopericardium, cardiac tamponade, massive hemorrhagic MI and death from cardiogenic shock have been associated with the use of some thrombolytic agents.
Rarely, cholesterol embolization syndrome presenting as peripheral cyanosis has been associated with alteplase therapy.[Ref]
The mortality rate among patients in the Thrombolysis in Myocardial Infarction (TIMI) study significantly increased with age, averaging 3.5% and 12% for patients less than 65 years and 70 to 76 years old, respectively. Risk factors for death were female gender, diabetes mellitus, extensive coronary artery disease, history of congestive heart failure, persistent chest pain after alteplase administration, low systolic blood pressure at presentation, and advanced age.[Ref]
A potentially life-threatening nervous system side effect, hemorrhagic stroke, has occurred in approximately 1% of patients with an acute myocardial infarction. Administration of 100 mg over 3 hours resulted in a 0.4% incidence of stroke, at 100 mg over 90 minutes the incidence was 0.7%, and at 150 mg over 90 minutes the rate of ICH was 1.3%. The incidence is significantly increased in patients with thrombotic stroke, with reports as high as 31% (4% to 10% experience worsening neurologic status). See "Hematologic" side effects. Rare cases of intracerebral hemorrhage associated with the use of t-PA in patients with cerebral amyloid angiopathy and cases of headache or subdural hematoma have been associated with alteplase.
Recurrent intracerebral embolization following alteplase has been reported in a patient with dilated cardiomyopathy. Alteplase may promote lysis and embolization of detached intracranial thrombi.
Stroke has occurred in 1.2% to 1.6% of patients experiencing an AMI and receiving alteplase as a 3 hour infusion or an accelerated infusion, respectively.
Rare cases of atheroembolic events have been associated with the use of this drug and other lytic agents.[Ref]
A retrospective meta-analysis of patients with intracranial hemorrhage (ICH) who had received alteplase (n = 88) versus no alteplase (n = 148) revealed the following independent predictors for ICH (odds ratio): age over 65 years (2.2), body weight below 70 kg (2.1), and hypertension on admission (2.0). Furthermore, the probability of ICH increased with the number of risk factors present. Other studies have corroborated these data, with some finding a higher Killip classification and the occurrence of anterior myocardial infarction as additional risk factors. These data do not account for other possible risk factors, such as extensive peripheral vascular disease, diabetes, or the use of oral anticoagulants.[Ref]
A 69-year-old beekeeper with acute myocardial infarction developed urticaria and gross facial, tongue, and neck edema within 25 minutes following administration of glyceryl trinitrate, nifedipine, aspirin, and alteplase. Investigations revealed normal complement (qualitative and quantitative measurements), the absence of circulating immune complexes, normal levels of circulating IgE, and absence of t-PA antibodies by ELISA. Intradermal skin testing with each drug revealed no allergic response. This anaphylactoid reaction did not appear to be due to an antibody-antigen or direct chemical reaction. This patient had a history of atopy. The authors suggested that clinicians who administer alteplase to strongly atopic individuals consider the possibility of an anaphylactoid reaction and have resuscitative measures available.
A 51-year-old woman with systemic lupus erythematosus and deep vein thrombosis developed throat tightness, dyspnea and dysphagia within 24 hours after receiving alteplase therapy. Subconjunctival bullous edema of the left eye and angioedema of the tongue, face, neck and upper lip were also observed. Associated laboratory findings included markedly decreased C4 and C1 esterase inhibitor levels relative to baseline. The patient's angioedema resolved within six hours after discontinuation of alteplase and initiation of steroid and antihistamine therapy.
A separate report documented two cases of anaphylactic reactions following treatment of 105 consecutive patients receiving alteplase for the treatment of ischemic stroke.[Ref]
Hypersensitivity reactions have occurred in less than 0.02% of patients. A cause-and-effect relationship between anaphylaxis and alteplase has not been clearly established.[Ref]
Gastrointestinal (GI) side effects generally have been limited to GI bleeding.[Ref]
Renal biopsy in a 76-year-old man with a history of angina, hypertension, and hypercholesterolemia who developed acute renal failure after alteplase therapy for an acute myocardial infarction revealed needle-shaped cholesterol crystals in small artery intima. There was mild focal segmental mesangial cell proliferation, tubular atrophy, and interstitial fibrosis. The patient required maintenance hemodialysis.[Ref]
Rare cases of cholesterol crystal embolization syndrome-associated renal failure have occurred during alteplase therapy.[Ref]
Bleeding has been the most frequent side effect noted with alteplase therapy. Arterial punctures are of particular concern and an upper extremity accessible to manual compression is preferred if arterial puncture is required. The usual precautions and procedures following arterial catheterization are extremely important. It is recommended that other invasive procedures be avoided or minimized. Non-compressible venous sites should be avoided.[Ref]
Hepatic side effects have been limited to rare (at least two cases) reports of hepatic cholesterol embolization syndrome.[Ref]
Local inflammation and/or ecchymosis may occur with extravasation during alteplase infusion.[Ref]
1. Scuba JR, Parrado C "Parapharyngeal hemorrhage secondary to thrombolytic therapy for acute myocardial infarction." J Oral Maxillofac Surg 50 (1992): 413-5
2. Li G, McDonald G, Chen P "A 63-year-old man who developed severe abdominal pain after thrombolytic therapy." Circulation 88 (1993): 2973-7
3. Williams DO, Topol EJ, Califf RM, Roberts R, Mancini GB, Joelson JM, Ellis SG, Kleiman NS "Intravenous recombinant tissue-type plasminogen activator in patients with unstable angina pectoris. Results of a placebo-controlled, randomized trial." Circulation 82 (1990): 376-83
4. Karnash SL, Granger CB, White HD, Woodlief LH, Topol EJ, Califf RM "Treating menstruating women with thrombolytic therapy: insights from the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO-i) trial." J Am Coll Cardiol 26 (1995): 1651-6
5. Simoons ML, Maggioni AP, Knatterud G, Leimberger JD, de Jaegere P, van Domburg R, Boersma E, Franzosi MG, Califf R, Schroder R, et al "Individual risk assessment for intracranial haemorrhage during thrombolytic therapy." Lancet 342 (1993): 1523-8
6. Hacke W, Kaste M, Fieschi C, et al. "Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European cooperative acute stroke study (ECASS)." JAMA 274 (1995): 1017-25
7. Renkin J, de Bruyne B, Benit E, Joris JM, Carlier M, Col J "Cardiac tamponade early after thrombolysis for acute myocardial infarction: a rare but not reported hemorrhagic complication." J Am Coll Cardiol 17 (1991): 280-5
8. Krolick MA, Cintron GB "Spinal epidural hematoma causing cord compression after tissue plasminogen activator and heparin therapy." South Med J 84 (1991): 670-1
9. Collins R, Sleight P, Maggioni AP "The risk of stroke after thrombolytic therapy ." N Engl J Med 327 (1992): 1531-2
10. Caputo R, Corrao JM, Lew R, Becker RC "Effect of serum total cholesterol on hemorrhagic complications following thrombolytic therapy for acute myocardial infarction." Cardiology 79 (1991): 211-8
11. Verstraete M, Su CA, Tanswell P, Feuerer W, Collen D "Pharmacokinetics and effects on fibrinolytic and coagulation parameters of two doses of recombinant tissue-type plasminogen activator in healthy volunteers." Thromb Haemost 56 (1986): 1-5
12. Pendlebury WW, Iole ED, Tracy RP, Dill BA "Intracerebral hemorrhage related to cerebral amyloid angiopathy and t- PA treatment." Ann Neurol 29 (1991): 210-3
13. Dalla-Volta S, Palla A, Santolicandro A, Giuntini C, Pengo V, Visioli O, Zonzin P, Zanuttini D, Barbaresi F, Agnelli G, et al "PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2." J Am Coll Cardiol 20 (1992): 520-6
14. Stolke D, Seifert V "Single intracisternal bolus of recombinant tissue plasminogen activator in patients with aneurysmal subarachnoid hemorrhage: preliminary assessment of efficacy and safety in an open clinical study." Neurosurgery 30 (1992): 877-81
15. London NJ, Williams B, Stein A "Systemic thrombolysis causing haemorrhage around a prosthetic abdominal aortic graft." BMJ 306 (1993): 1530-1
16. Chaitman BR, Thompson B, Wittry MD, Stump D, Hamilton WP, Hillis LD, Dwyer JG, Solomon RE, Knatterud GL "The use of tissue-type plasminogen activator for acute myocardial infarction in the elderly: results from thrombolysis in myocardial infarction Phase I, open label studies and the Thrombolysis inMyocardial Infarction Phase II pilot study. The TIMI Inve." J Am Coll Cardiol 14 (1989): 1159-65
17. Segal LS, Adair DM "Compartment syndrome of the triceps as a complication of thrombolytic therapy." Orthopedics 13 (1990): 90-2
18. Fromm RE, Hoskins E, Cronin L, Pratt CM, Spencer WH, Roberts R "Bleeding complications following initiation of thrombolytic therapy for acute myocardial infarction: a comparison of helicopter- transported and nontransported patients." Ann Emerg Med 20 (1991): 892-5
19. LATE Study Group "Late assessment of thrombolytic efficacy (LATE) study with alteplase 6-24 hours after onset of acute myocardial infarction." Lancet 342 (1993): 759-66
20. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. "Tissue plasminogen activator for acute ischemic stroke." N Engl J Med 333 (1995): 1581-7
21. Califf RM, Topol EJ, George BS, Boswick JM, Abbottsmith C, Sigmon KN, Candela R, Masek R, Kereiakes D, O'Neill WW, et al "Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in treatment of acute myocardial infarction." Am J Med 85 (1988): 353-9
22. Bero CJ, Cardella JF, Reddy K, Fox PS, Healy DA, Jaffe J, Nicholas GG "Recombinant tissue plasminogen activator for the treatment of lower extremity peripheral vascular occlusive disease." J Vasc Interv Radiol 6 (1995): 571-7
23. Aggarwal K, Tjahja IE "Atheroembolic disease following administration of tissue plasminogen activator (TPA)." Clin Cardiol 19 (1996): 906-8
24. Barrington WW, Smith JE, Himmelstein SI "Cardiac tamponade following treatment with tissue plasminogen activator: an atypical hemodynamic response to pericardiocentesis." Am Heart J 121 (1991): 1227-9
25. Levine MN, Goldhaber SZ, Gore JM, Hirsh J Califf RM "Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism." Chest 108 Suppl (1995): s291-301
26. Kase CS, O'Neal AM, Fisher M, Girgis GN, Ordia JI "Intracranial hemorrhage after use of tissue plasminogen activator for coronary thrombolysis." Ann Intern Med 112 (1990): 17-21
27. Tanne D, Turgeman D, Adler Y "Management of acute ischaemic stroke in the elderly: tolerability of thrombolytics." Drugs 61 (2001): 1439-53
28. Ward AS, Cripps N "Remote transgraft hemorrhage complicating thrombolysis with tissue plasminogen activator." AJR Am J Roentgenol 161 (1993): 1335-6
29. von Kummer R, Hacke W "Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke." Stroke 23 (1992): 646-52
30. Gwynn M "tPA in acute stroke--risk or reprieve?" J Neurosci Nurs 25 (1993): 180-6
31. Wagstaff AJ, Gillis JC, Goa KL "Alteplase - a reappraisal of its pharmacology and therapeutic use in vascular disorders other than acute myocardial infarction." Drugs 50 (1995): 289-316
32. Tebbe U, von Essen R, Smolarz A, Limbourg P, Rox J, Rustige J, Vogt A, Wagner J, Meyer-Sabellek W, Neuhaus KL "Open, noncontrolled dose-finding study with a novel recombinant plasminogen activator (BM 06.022) given as a double bolus in patients with acute myocardial infarction." Am J Cardiol 72 (1993): 518-24
33. Birnbaum Y, Stahl B, Rechavia E "Spontaneous hemarthrosis following thrombolytic therapy for acute myocardial infarction." Int J Cardiol 40 (1993): 289-90
34. Stein PD, Hull RD "Relative risks of anticoagulant treatment of acute pulmonary embolism based on an angiographic diagnosis vs a ventilation/perfusion scan diagnosis." Chest 106 (1994): 727-30
35. Kase CS, Pessin MS, Zivin JA, del Zoppo GJ, Furlan AJ, Buckley JW, Snipes RG, LittleJohn JK "Intracranial hemorrhage after coronary thrombolysis with tissue plasminogen activator." Am J Med 92 (1992): 384-90
36. Katzan IL, Furlan AJ, Lloyd LE, et al. "Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience." JAMA 283 (2000): 1151-8
37. Goldhaber SZ, Haire WD, Feldstein ML, et al. "Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion." Lancet 341 (1993): 507-11
38. Gurwitz JH, Gore JM, Goldberg RJ, et al. "Risk for intracranial hemorrhage after tissue plasminogen activator treatment for acute myocardial infarction." Ann Intern Med 129 (1998): 597-604
39. Fisher M "ECASS: lessons for future thrombolytic stroke trials." JAMA 274 (1995): 1058-9
40. Austin SM, Caro M, Gemmel D "Community hospital experience with recombinant tissue plasminogen activator in acute myocardial infarction." J Gen Intern Med 7 (1992): 187-90
41. del Zoppo GJ, Poeck K, Pessin MS, Wolpert SM, Furlan AJ, Ferbert A, Alberts MJ, Zivin JA, Wechsler L, Busse O, et al "Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke." Ann Neurol 32 (1992): 78-86
42. Maizel AS, Bookstein JJ "Streptokinase, urokinase, and tissue plasminogen activator: pharmacokinetics, relative advantages, and methods for maximizing rates and consistency of lysis." Cardiovasc Intervent Radiol 9 (1986): 236-44
43. "Product Information. Activase (alteplase)." Genentech, South San Francisco, CA.
44. McLeod DC, Coln WG, Thayer CF, Perfetto EM, Hartzema AG "Pharmacoepidemiology of bleeding events after use of r-alteplase or streptokinase in acute myocardial infarction." Ann Pharmacother 27 (1993): 956-62
45. Gore JM, Sloan M, Price TR, Randall AM, Bovill E, Collen D, Forman S, Knatterud GL, Sopko G, Terrin ML "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 (1991): 448-59
46. Garcia-Rubira JC, Lopez V, Rojas J, Garcia-Martinez JT, Cruz JM "Thrombolytic therapy soon after left heart catheterization--is it safe?" Intensive Care Med 17 (1991): 501-3
47. Meneveau N, Bassand JP, Schiele F, Bouras Y, Anguenot T, Bernard Y, Schultz R "Safety of thrombolytic therapy in elderly patients with massive pulmonary embolism: a comparison with nonelderly patients." J Am Coll Cardiol 22 (1993): 1075-9
48. Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G "The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), andThe International Study Group." N Engl J Med 327 (1992): 1-6
49. Kaufman HH, McAllister P, Taylor H, Schmidt S "Intracerebral hematoma related to thrombolysis for myocardial infarction." Neurosurgery 33 (1993): 898-900discussion900
50. Khoury NE, Borzak S, Gokli A, Havstad SL, Smith ST, Jones M "''inadvertent'' thrombolytic administration in patients without myocardial infarction: clinical features and outcome." Ann Emerg Med 28 (1996): 289-93
51. Da Silva VF, Bormanis J "Intracerebral hemorrhage after combined anticoagulant-thrombolytic therapy for myocardial infarction: two case reports and a short review." Neurosurgery 30 (1992): 943-5
52. Hacke W, Kaste M, Fieschi C, et al. "Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS)." Lancet 352 (1998): 1245-51
53. Sors H, Pacouret G, Azarian R, Meyer G, Charbonnier B, Simonneau G "Hemodynamic effects of bolus vs 2-h infusion of alteplase in acute massive pulmonary embolism - a randomized controlled multicenter trial." Chest 106 (1994): 712-7
54. O'Donnell M "Battle of the clotbusters." BMJ 302 (1991): 1259-61
55. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S "Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset: the Atlantis study: a randomised controlled trial." JAMA 282 (1999): 2019-26
56. Grijseels EWM, Bouten MJM, Lenderink T, Deckers JW, Hoes AW, Hartman JAM, Vanderdoes E, Simoons ML "Pre-hospital thrombolytic therapy with either alteplase or streptokinase - practical applications, complications and long-term results in 529 patients." Eur Heart J 16 (1995): 1833-8
57. Sherry S "Appraisal of various thrombolytic agents in the treatment of acute myocardial infarction." Am J Med 83 (1987): 31-46
58. Diehl JL, Meyer G, Igual J, et al. "Effectiveness and safety of bolus administration of alteplase in massive pulmonary embolism." Am J Cardiol 70 (1992): 1477-80
59. Van de Werf F "Lessons from the European Cooperative recombinant tissue-type plasminogen activator (rt-PA) versus placebo trial." J Am Coll Cardiol 12 (1988): a14-9
60. Suddes KP, Thomas RD "Mediastinal haemorrhage: a complication of thrombolytic treatment." BMJ 297 (1988): 527
61. Hermann DM, Matter CM "Tissue plasminogen activator-induced reperfusion injury after stroke revisited." Circulation 116 (2007): 363-5
62. Topol EJ, Herskowitz A, Hutchins GM "Massive hemorrhagic myocardial infarction after coronary thrombolysis." Am J Med 81 (1986): 339-43
63. Wrenn K "Tissue plasminogen activator-associated lingual artery hemorrhage." Ann Emerg Med 19 (1990): 1184-6
64. Ball MJ "Iatrogenic amyloidotic apoplexy." Ann Neurol 30 (1991): 229
65. McKendall GR, Attubato MJ, Drew TM, Feit F, Sharaf BL, Thomas ES, Teichman S, McDonald MJ, Williams DO "Safety and efficacy of a new regimen of intravenous recombinant tissue-type plasminogen activator potentially suitable for either prehospital or in-hospital administration." J Am Coll Cardiol 18 (1991): 1774-8
66. Perazella MA, Buller GK "Hemorrhagic bursitis complicating treatment with recombinant tissue plasminogen activator ." Am J Med 91 (1991): 440-2
67. Nathan PE, Sonenblick D, Chakote V, Wolf R, Sacchi TJ "Headache, thrombolytic therapy, and chronic subdural hemorrhage--a case report." Angiology 45 (1994): 77-80
68. Turi ZG, Goldberg S, LittleJohn JK, Vander Ark C, Shadoff N, Karlsberg R, Williams J, Butman S, Stadius ML, Wise K, et al "Dose-related efficacy and bleeding complications of double-chain tissue plasminogen activator in acute myocardial infarction. The Wellcome Tissue Plasminogen Activator Study Group." Am J Cardiol 71 (1993): 1009-14
69. Dabbs CK, Aaberg TM, Aguilar HE, Sternberg P, Jr Meredith TA, Ward AR "Complications of tissue plasminogen activator therapy after vitrectomy for diabetes." Am J Ophthalmol 110 (1990): 354-60
70. Blankenship J, Indeck M "Splenic hemorrhage after tissue plasminogen activator for acute myocardial infarction ." N Engl J Med 325 (1991): 969
71. Shaps HJ, Snyder GE, Sama AE, Rudolph GS "Airway compromise secondary to lingual hematoma complicating administration of tissue plasminogen activator for acute ischemic stroke." Ann Emerg Med 38 (2001): 447-9
72. Engelter ST, Fluri F, Buitrago-Tellez C, et al. "Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke." J Neurol 252 (2005): 1167-70
73. Mohler ER, Stark KS, Kent KM "Conservative management complications after thrombolytic therapy." Am Heart J 121 (1991): 591-3
74. Bhardwaj M, Goldweit R, Erlebacher J, Kashani M, Levin D, Leber G "Tissue plasminogen activator and cholesterol crystal embolization ." Ann Intern Med 111 (1989): 687-8
75. Berger PB, Ruocco NA, Ryan TJ, Frederick MM, Jacobs AK, Faxon DP "Incidence and prognostic implications of heart block complicating inferior myocardial infarction treated with thrombolytic therapy: results from TIMI II." J Am Coll Cardiol 20 (1992): 533-40
76. Arora RR, Magun AM, Grossman M, Katz J "Cholesterol embolization syndrome after intravenous tissue plasminogen activator for acute myocardial infarction." Am Heart J 126 (1993): 225-8
77. Wilcox RG, Eastgate J, Harrison E, Skene AM "Ventricular arrhythmias during treatment with alteplase (recombinant tissue plasminogen activator) in suspected acute myocardial infarction." Br Heart J 65 (1991): 4-8
78. Gupta BK, Spinowitz BS, Charytan C, Wahl SJ "Cholesterol crystal embolization-associated renal failure after therapy with recombinant tissue-type plasminogen activator." Am J Kidney Dis 21 (1993): 659-62
79. Shapiro LS "Cholesterol embolization after treatment with tissue plasminogen activator ." N Engl J Med 321 (1989): 1270
80. Baglin TP, Luddington R, Jennings I, Richards EM "Thrombin generation and myocardial infarction during infusion of tissue-plasminogen activator." Lancet 341 (1993): 504-5
81. Genser N, Mair J, Maier J, Dienstl F, Puschendorf B, Lechleitner P "Thrombin generation during infusion of tissue-type plasminogen activator." Lancet 341 (1993): 1038
82. Ellicott C, Shaw DB, Kirby BJ, Bailey T "Coronary care follow-up study: acute care required immediately following thrombolytic therapy." J R Soc Med 86 (1993): 324-7
83. Koudstaal PJ, Stibbe J, Vermeulen M "Fatal ischaemic brain oedema after early thrombolysis with tissue plasminogen activator in acute stroke." BMJ 297 (1988): 1571-4
84. Yasaka M, Yamaguchi T, Yonehara T, Moriyasu H "Recurrent embolization during intravenous administration of tissue plasminogen activator in acute cardioembolic stroke. A case report." Angiology 45 (1994): 481-4
85. Chodirker WB "Reactions to alteplase in patients with acute thrombotic stroke." Can Med Assn J 163 (2000): 387-8
86. Purvis JA, Booth NA, Wilson CM, Adgey AA, McCluskey DR "Anaphylactoid reaction after injection of alteplase." Lancet 341 (1993): 966-7
87. Hill MD, Barber PK, Takahashi J, Demchuk AM, Feasby TE, Buchan AM "Reactions to alteplase in patients with acute thrombotic stroke - Reply." Can Med Assn J 163 (2000): 388-9
88. Hill MD, Barber PA, Takahashi J, Demchuk AM, Feasby TE, Buchan AM "Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke." Can Med Assn J 162 (2000): 1281-4
89. Francis CW, Brenner B, Leddy JP, Marder VJ "Angioedema during therapy with recombinant tissue plasminogen activator." Br J Haematol 77 (1991): 562-3
Not all side effects for alteplase may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
More about alteplase
Related treatment guides
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.