Cargando…

Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid

Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with v...

Descripción completa

Detalles Bibliográficos
Autores principales: Romero, Cynthia, Shartar, Samuel, Carr, Michael J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012568/
https://www.ncbi.nlm.nih.gov/pubmed/32064426
http://dx.doi.org/10.5811/cpcem.2019.10.44369
_version_ 1783496252031238144
author Romero, Cynthia
Shartar, Samuel
Carr, Michael J.
author_facet Romero, Cynthia
Shartar, Samuel
Carr, Michael J.
author_sort Romero, Cynthia
collection PubMed
description Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA’s fibrinolytic effects.
format Online
Article
Text
id pubmed-7012568
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine
record_format MEDLINE/PubMed
spelling pubmed-70125682020-02-14 Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid Romero, Cynthia Shartar, Samuel Carr, Michael J. Clin Pract Cases Emerg Med Case Report Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA’s fibrinolytic effects. University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine 2019-12-17 /pmc/articles/PMC7012568/ /pubmed/32064426 http://dx.doi.org/10.5811/cpcem.2019.10.44369 Text en Copyright: © 2020 Romero et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Case Report
Romero, Cynthia
Shartar, Samuel
Carr, Michael J.
Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title_full Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title_fullStr Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title_full_unstemmed Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title_short Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid
title_sort pericardial tamponade after systemic alteplase in stroke and emergent reversal with tranexamic acid
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012568/
https://www.ncbi.nlm.nih.gov/pubmed/32064426
http://dx.doi.org/10.5811/cpcem.2019.10.44369
work_keys_str_mv AT romerocynthia pericardialtamponadeaftersystemicalteplaseinstrokeandemergentreversalwithtranexamicacid
AT shartarsamuel pericardialtamponadeaftersystemicalteplaseinstrokeandemergentreversalwithtranexamicacid
AT carrmichaelj pericardialtamponadeaftersystemicalteplaseinstrokeandemergentreversalwithtranexamicacid