Thrombolytic therapy is associated with a major risk of bleeding complications. Bleeding may be related to known or occult pathology (e.g. peptic ulceration, ulcerative colitis). Physical handling of the patient should be restricted and intramuscular injections avoided. Essential arterial punctures should be confined to the upper extremity vessels, with prolonged pressure and regular checking of the site. Arterial punctures prior to fibrinolytic therapy must be closely monitored, particularly sites through which arteriograms have been performed. Compression devices can be used before thrombolytic therapy is given. Spontaneous soft tissue hemorrhage, particularly retroperitoneal, may occur and patients should avoid strain on their iliopsoas muscles (i.e. sitting up and down in bed). The most feared complication is intracerebral hemorrhage, which may occur in 0.5 to 1 per cent of cases and is likely to be fatal. Risk factors for intracerebral hemorrhage include advanced age, female sex, low body weight, hypertension, and history of cerebrovascular disease. Patients with diabetes and concurrent oral anticoagulant therapy may also have a higher risk of intracerebral hemorrhage.

During strepokinase therapy, circulating fibrinogen levels are reduced to 10 to 20 per cent of normal for up to 24 h. Although alteplase lowers fibrinogen levels less than streptokinase, the incidence of hemorrhagic complications with alteplase is not lower. Intracerebral hemorrhage is more common after tissue plasminogen activator than after streptokinase. Hemorrhagic complications of thrombolytic therapy do not correlate well with the degree of reduction in circulating fibrinogen levels, but correlate with the presence of localized vascular injury. Management of established bleeding complications of thrombolytic therapy includes cessation of therapy; including heparin (protamine sulfate may be indicated) and aspirin. If coagulation tests indicate factor deficiencies, cryoprecipitate and fresh frozen plasma may be necessary. If bleeding persists, administration of antifibrinolytic agents should be considered.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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