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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine
2019
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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 |
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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 |
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