FBS
Alteplase


Contraindications

- Significant bleeding now or within the previous 6 months;

- Simultaneous administration of oral anticoagulants such as sodium warfarin (INR > 1.3);

- Any damage and diseases of the central nervous system in the history (including neoplasms, aneurysm, brain and spinal cord surgery;

- Intracranial (including subarachnoid) haemorrhage currently or in history; suspected hemorrhagic stroke;

- Severe uncontrollable arterial hypertension;

- Extensive surgical intervention or significant injury in the previous 10 days (including any injury in combination with this acute myocardial infarction), recent brain injury;

- Prolonged or traumatic cardiopulmonary resuscitation (> 2 minutes), delivery in the previous 10 days; recent puncture of a blood vessel inaccessible to pressure (e.g., subclavian or jugular vein);





Alteplase Therapeutic indications

- Severe liver diseases, including liver failure, cirrhosis, portal hypertension (including esophageal varicose veins) and active hepatitis;

- Hemorrhagic retinopathy, for example, in diabetes mellitus (vision disorders may indicate hemorrhagic retinopathy), other hemorrhagic eye diseases;

- Bacterial endocarditis;

- Acute pancreatitis;

- Confirmed gastric or duodenal ulcer disease within the last 3 months;

- Arterial aneurysms, arterial/ven developmental defects;

- neoplasms with increased risk of bleeding;

- Hypersensitivity to drug components.

- If the drug is used to treat acute myocardial infarction and pulmonary embolism, in addition to the above, there are the following additional contraindications:

- Stroke in the anamnesis.

- If you use the drug for the treatment of acute ischemic stroke, in addition to the above, there are the following contraindications:

- Start of symptoms of ischemic stroke more than 3 hours before the beginning of infusion, or lack of precise information about the time of onset of symptoms;

- Rapid improvement in acute ischemic stroke, or poor symptomatology at the time of infusion;

- Severe stroke, based on clinical data (e.g., NIHSS > 25) and/or appropriate imaging techniques;

- Seizure at the start of a stroke;

- Information on stroke or serious head injury suffered during the previous 3 months;

- Combination of previous stroke and diabetes mellitus;

- Use of heparin for 48 hours before the start of a stroke if the activated partial thromboplastin time (ACTT) is increased at this time;

- Use of antiaggregants at the time of infusion and within the first 24 hours after infusion;

- Platelet count less than 100,000/mm3;

- In the treatment of acute ischemic stroke, the following special precautions and measures should be additionally taken into account: the use of actilise in patients with acute ischemic stroke, compared to the use of this drug for other indications, is accompanied by a markedly higher risk of intracranial hemorrhage, since bleeding occurs mainly in the area of brain attack. This is particularly important to take into account in the following cases:

- All conditions listed in the "contraindications" section and generally all conditions with a high risk of bleeding;

https://www.ncbi.nlm.nih.gov/books/NBK499977/