Complications of thrombolysis and their clinical management

Serious bleeding complications are 'thankfully' a rare complication of thrombolytic therapy. Careful case selection and meticulous invasive techniques are important contributors to this. Early recognition of bleeding, prompt termination of thrombolysis, administration of plasmin inhibitors and fibrinogen repletion are the major steps in correcting the haemostatic defect. Allergic complications are also rare, particularly with alteplase or urokinase. These agents should be used electively in all patients previously exposed to streptokinase or anistreplase. Most allergic reactions are self-terminating and do not lead to long-term sequelae. Iatrogenic complications of catheter insertion can be avoided by technically-correct and careful catheter placement, but unnecessary vascular intervention should be avoided.