Q:  What different options are available, in case patient develops life-threatening bleeding as a complication of fibrinolytic therapy?


Answer: If a patient treated with fibrinolytic develops serious bleeding, the first step is to stop the fibrinolytic agent and any anticoagulants. Hemodynamic stability with volume and pressors as suppoprtive therapy is vital.

Aminocaproic acid: Aminocaproic acid is a specific antidote to fibrinolytic agents. Loading dose is 4-5 g of aminocaproic acid over one hour, followed by a continuing infusion at the rate of 1 g / hour. Infusion is continued for about 8 hours or until the bleeding situation has been controlled. Aminocaproic acid should not be given unless hemorrhage is life-threatening, because it inhibits intrinsic fibrinolytic activity.

Blood products: FFP, cryoprecipitate, or both may be used to replenish fibrin and clotting factors.