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Thrombolytic Therapy: tPA-Induced Bleeding

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Management of Bleeding Patients

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Abstract

Tissue plasminogen activator is used in the management of acute arterial ischemic stroke, myocardial infarction, and massive pulmonary embolism. tPA has been shown to improve outcomes in these conditions, but its use is not without risk. Significant bleeding tends to happen at a fairly low rate overall; however, it can have serious complications necessitating prompt recognition and urgent intervention. The most concerning complication is massive intracerebral hemorrhage which carries a high risk of morbidity and mortality. There is limited data available to support best practice in the management of tPA-related hemorrhage and there is wide variation in current practice. Expert opinion supports correction of coagulopathy with cryoprecipitate. Additionally, tranexamic acid or ε-aminocaproic acid may be considered for acute treatment. Surgical options exist although current studies examining surgery in this setting are inconclusive. Future research is necessary to establish most effective treatment for the management of bleeding associated with tPA in order to minimize consequences and improve functional outcome of surviving patients.

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Authors and Affiliations

  1. Departments of Neurology and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, 6701 Fannin Street, Suite 1250, Houston, TX, 77030, USA

    Jennifer C. Erklauer M.D.

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  1. Jennifer C. Erklauer M.D.
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Correspondence to Jennifer C. Erklauer M.D. .

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  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine Division of Transfusion Medicine & Coagulation Texas Children’s Hospital, Houston, Texas, USA

    Jun Teruya

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Erklauer, J.C. (2016). Thrombolytic Therapy: tPA-Induced Bleeding. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_26

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  • DOI: https://doi.org/10.1007/978-3-319-30726-8_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

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