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| Interactions: | Acenocoumarol
Adverse Effect: excessive bleeding Clinical Management: Coadministration of alteplase and acenocoumarol is contraindicated if the patients prothrombin time is greater than 15 seconds. The combination of alteplase and oral anticoagulants significantly raises the risk of internal or external hemorrhaging.
Glyceryl Trinitrate
Adverse Effect: less coronary artery reperfusion, longer time to reperfusion, and more coronary artery reocclusion Clinical Management: Concomitant use of nitroglycerin and alteplase should be avoided if possible. If coadministration is necessary, the lowest effective dose of nitroglycerin should be used. Be aware that alteplase efficacy may be decreased and the risk of reocclusion may be increased.
Heparin
Adverse Effect: excessive bleeding Clinical Management: Alteplase is contraindicated in patients who received heparin within 48 hours preceding the onset of a stroke and if the patient has an elevated activated partial thromboplastin time (aPPT) at the time of presentation. The combination of alteplase and heparin significantly raises the risk of internal or external hemorrhaging.
Phenindione
Adverse Effect: excessive bleeding Clinical Management: Coadministration of alteplase and phenindione is contraindicated if the patients prothrombin time is greater than 15 seconds. The combination of alteplase and oral anticoagulants significantly raises the risk of internal or external hemorrhaging.
Warfarin
Adverse Effect: excessive bleeding Clinical Management: Coadministration of alteplase and warfarin is contraindicated if the patients prothrombin time is greater than 15 seconds. The combination of alteplase and oral anticoagulants significantly raises the risk of internal or external hemorrhaging.
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