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.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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