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  • Title: Fatal Intraperitoneal Bleeding after Intravenous Administration of Tissue Plasminogen Activator.
    Author: Anan C, Oomura M, Saeki T, Ikeda T, Sato C, Yamada K.
    Journal: J Stroke Cerebrovasc Dis; 2015 Jul; 24(7):e177-8. PubMed ID: 25899160.
    Abstract:
    We report a case of acute ischemic stroke, which developed fatal intraperitoneal bleeding after intravenous administration of alteplase. An 86-year-old woman developed acute infarction of the right middle cerebral artery during admission for chronic heart failure. Two days before the stroke, liver biopsy was performed; the result was benign. Although rivaroxaban was prescribed for atrial fibrillation, the rivaroxaban had been discontinued for liver biopsy until the time when she developed the stroke. A condition of recent biopsy required careful determination of eligibility of intravenous alteplase; however, we considered that the benefit of intravenous alteplase outweighed the hemorrhagic adverse effects. Alteplase (0.6 mg/kg) was started 2 hours after the stroke onset, however, no clinical improvement was obtained. One hour after the completion of alteplase, she suddenly developed a shock state. Emergent computed tomography disclosed massive intraperitoneal hemorrhage. She died 8 hours after the completion of alteplase. In the present case, mechanical thrombectomy without intravenous alteplase can be an alternative therapeutic option.
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