Adverse Effects

The principal adverse effect associated with throm-bolytic therapy is bleeding due to fibrinogenolysis or fibrinolysis at the site of vascular injury. Hypo-fibrinogenemia may occur and should be monitored with laboratory tests. At effective thrombolytic doses, the second- and third-generation agents cause less extensive fibrinogenolysis, but bleeding occurs with a similar incidence for all agents. Life-threatening intracra-nial bleeding may necessitate stoppage of therapy, administration of whole blood, platelets or fresh frozen plasma, protamine (if heparin is present), and an an-tifibrinolytic drug (discussed later).

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