Drug General Information (ID: DDI219OQH6)
Drug Name			Anistreplase		Drug Info		Heparin		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Thrombolytics				Anticoagulants

Mechanism of Anistreplase-Heparin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Anistreplase				Heparin
Mechanism		Risk of bleeding Thrombolytic agent				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Anistreplase and Heparin

Recommended Action
Management		Alteplase is contraindicated in patients with acute ischemic stroke who have received heparin within the last 48 hours and have an elevated activated partial thromboplastin time (aPTT). Patients who are to receive a thrombolytic plus heparin for other indications should be carefully selected according to recommended eligibility criteria. The heparin dosage should be adjusted as appropriate to maintain therapeutic aPTT values. Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Thrombolytic and/or anticoagulation therapy should be discontinued immediately if serious or uncontrollable bleeding occurs.

References
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5	Product Information. Abbokinase (urokinase). Abbott Pharmaceutical, Abbott Park, IL.
6	Product Information. Activase (alteplase). Genentech, South San Francisco, CA.
7	Product Information. Retavase (reteplase). Boehringer Mannheim, Gaithersburg, MD.
8	Product Information. Streptase (streptokinase). Astra USA, Westborough, MA.
9	Product Information. TNKase (tenecteplase) Genentech, South San Francisco, CA.
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