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Updated: May 7, 2026
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An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug
Published on: June 4, 2021
Anaphylactic shock associated with intravenous thrombolytics.
Amna Zarar1, Asif A Khan1, Malik M Adil1
1Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 56303, USA.
The American Journal of Emergency Medicine
|October 5, 2013
Summary
Anaphylactic reactions can occur with intravenous thrombolytics, particularly alteplase. Prompt recognition and treatment are crucial for managing these serious allergic adverse events.
Area of Science:
- Cardiology
- Pharmacology
- Immunology
Background:
- Thrombolytic therapy is crucial for acute ischemic events.
- Known adverse events include intracerebral hemorrhage and arrhythmias.
- Allergic reactions to thrombolytics are less commonly reported.
Observation:
- A case of anaphylaxis to intravenous recombinant tissue plasminogen activator was identified.
- A systematic review of FDA Adverse Event Reporting System data (2004-2012) was conducted.
- 33 cases of allergic events associated with thrombolytics were analyzed, with 12 directly attributed to IV thrombolytics.
Findings:
- Allergic reactions included angioedema, urticaria, hypotension, and anaphylactic shock.
- Alteplase was implicated in 11 of 12 cases; reteplase in 1 case.
- Most alteplase reactions resolved with standard treatment; one death occurred with reteplase.
Implications:
- Intravenous alteplase, despite being identical to endogenous t-PA, is a frequent cause of allergic reactions.
- Physician awareness of these allergic risks is essential for timely diagnosis and management.
- Further research into the immunogenicity of recombinant tissue plasminogen activators may be warranted.
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