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Case Reports
. 2019 Dec 17;4(1):55-58.
doi: 10.5811/cpcem.2019.10.44369. eCollection 2020 Feb.

Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid

Cynthia Romero  1 , Samuel Shartar  1   2 , Michael J Carr  1
Affiliations
Case Reports

Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid

Cynthia Romero et al. Clin Pract Cases Emerg Med. .

Abstract

Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA's fibrinolytic effects.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image
Image
In this subxiphoid view obtained with a phased array, point-of-care ultrasound probe, there is obvious pericardial effusion with right ventricular wall collapse. This demonstrates pericardial tamponade physiology in combination with the patient’s vital signs and physical exam findings. RV, right ventricle; LV, left ventricle; RA, right atrium; PE, pericardial effusion.
See this image and copyright information in PMC

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