Avoid Trouble: Choose Reteplase Candidates with Care

Because thrombolytic therapy increases the risk of bleeding, reteplase (r-PA, Penzberg, Germany-based Boehringer Mannheim’s Retavase) is contraindicated in the following situations:

4 Active internal bleeding

4 History of cerebrovascular accident

4 Recent intracranial or intraspinal surgery or trauma

4 Intracranial neoplasm, arteriovenous malformation, or aneurysm

4 Known bleeding diathesis

4 Severe uncontrolled hypertension

In the following conditions, the risks of reteplase therapy may increase:

4 Recent major surgery

4 Previous puncture of noncompressible vessels

4 Cerebrovascular disease

4 Recent gastrointestinal or genitourinary bleeding

4 Recent trauma

4 Hypertension systolic BP > 180 mm Hg and/or diastolic BP >110 mm Hg

4 High likelihood of left heart thrombus, for example, mitral stenosis with atrial fibrillation

4 Acute pericarditis

4 Subacute bacterial endocarditis

4 Hemostatic defects including those secondary to severe hepatic or renal disease

4 Severe hepatic or renal dysfunction

4 Pregnancy

4 Diabetic hemorrhagic retinopathy or other hemorrhagic ophthalmic conditions

4 Septic thrombophlebitis or occluded AV cannula at a seriously infected site

4 Advanced age

4 Patients receiving oral anticoagulants, such as warfarin sodium

4 Any other condition in which bleeding constitutes a significant hazard or would be particularly difficult to manage because of its location