What are the side effects of Alteplase?

Alteplase is a tissue plasminogen activator (tPA) used to dissolve blood clots in patients experiencing acute ischemic stroke, myocardial infarction (heart attack), or pulmonary embolism. While it can be life-saving, its administration is not without potential side effects. Understanding these side effects is crucial for both healthcare providers and patients to make informed decisions about its use.

One of the most significant side effects of alteplase is bleeding, which can range from minor to severe. This bleeding can occur at the site of injection or internally, such as in the gastrointestinal tract or brain. Intracranial hemorrhage is a particularly serious risk, especially in patients treated for stroke. The likelihood of bleeding increases in patients with conditions such as hypertension, recent surgery, or a history of gastrointestinal ulcers.

Another possible side effect is allergic reactions, although these are relatively rare. Such reactions can present as rash, itching, or more severe symptoms such as difficulty breathing and anaphylaxis. Patients with known hypersensitivity to alteplase or its components should avoid its use.

Hypotension, or low blood pressure, can also occur during or after the administration of alteplase. This side effect may manifest as dizziness, light-headedness, or fainting. Monitoring blood pressure closely during treatment is essential to manage and mitigate this risk.

Some patients may experience fever following alteplase administration. While generally not severe, a fever can be uncomfortable and may require symptomatic treatment. The exact cause of fever in this context is not well understood but is thought to be related to the body's response to the drug and the dissolution of the clot.

Nausea and vomiting are also noted side effects. These gastrointestinal symptoms can be distressing but are typically manageable with standard anti-emetic therapies. Proper hydration and supportive care are essential to alleviate these symptoms.

Bruising and hematoma formation at injection sites are additional concerns. While these are usually minor and self-limiting, they can be bothersome and occasionally may require medical attention, particularly if they become large or painful.

Additionally, arrhythmias, or irregular heartbeats, can occur, particularly in patients treated for myocardial infarction. These cardiac irregularities can range from benign to life-threatening and necessitate careful cardiac monitoring during and after treatment with alteplase.

In rare cases, systemic embolization can occur, where fragments of the clot break off and travel to other parts of the body, potentially causing further complications. This risk highlights the need for thorough assessment and monitoring during alteplase therapy.

Finally, neurological side effects can arise, particularly in patients treated for stroke. These might include seizures, confusion, or other changes in mental status. Such symptoms necessitate immediate medical evaluation to determine their cause and appropriate treatment.

In conclusion, while alteplase is a powerful and effective treatment for certain types of blood clots, its administration comes with a range of potential side effects. These can include bleeding, allergic reactions, hypotension, fever, nausea, arrhythmias, systemic embolization, and neurological changes. Thorough patient assessment, careful monitoring, and appropriate supportive care are pivotal to managing these risks and ensuring the best possible outcomes for patients.