Andrew Webster wrote:
>
> Is any body aware of some evidence based guidelines for decisions
> regarding thrombolysis for people on warfarin.
>
> Andy Webster
Dear Andy,
It is not a contra-indication for administration in our care pathway
(acute MI).
Literature of interest:
"Inducers or inhibitors of the cytochrome P450 system are not reported
to affect the pharmacokinetics of any thrombolytic agent. Since the
elimination of the recombinant plasminogen activators saruplase and
alteplase is dependent on liver blood flow, drugs affecting hepatic
blood flow could theoretically affect the hepatic clearance of these
agents. In fact, a reduction in thrombolytic activity has only been
demonstrated for alteplase with nitroglycerin (glyceryl trinitrate).
Pharmacodynamic interactions occur more often. ... No data are available
on the interaction between ticlopidine or clopidogrel and thrombolytic
agents in humans. ... Although there has been no controlled study on the
interaction between oral anticoagulants and thrombolytic agents,
patients with myocardial infarction who were taking an oral
anticoagulant before admission seem to be at higher risk for
intracranial haemorrhage during thrombolytic therapy. Currently, no
recommendations can be given for possible dose adjustment of
thrombolytic therapy in patients receiving antiplatelet co-medication."
Drug Saf 2000 Nov;23(5):391-9
Thrombolytics: drug interactions of clinical significance.
Harder S, Klinkhardt U.
Anton
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