Avoid Trouble: Choose Reteplase Candidates with Care
January 1, 1998
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
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