Drug General Information (ID: DDI8S5Q7H4)
Drug Name			Alteplase		Drug Info		Danaparoid		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Thrombolytics				Anticoagulants

Mechanism of Alteplase-Danaparoid Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Alteplase				Danaparoid
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 Alteplase and Danaparoid

Recommended Action
Management		In general, any agent that can enhance the risk of hemorrhage including other anticoagulants should be discontinued prior to initiation of LMWH, heparinoid, or fondaparinux therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended. Patients undergoing neuraxial intervention and treated with these agents should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. The optimal timing between the administration of anticoagulants and neuraxial procedures is not known.

References
1	Price AJ, Frcpath DO "Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?" Ann R Coll Surg Engl 77 (1995): 395. [PMID: 7486773]
2	Product Information. Arixtra (fondaparinux). Organon, West Orange, NJ.
3	Product Information. Fragmin (dalteparin). Pharmacia and Upjohn, Kalamazoo, MI.
4	Product Information. Innohep (tinzaparin) DuPont Pharmaceuticals, Wilmington, DE.
5	Product Information. Lovenox (enoxaparin). Rhone-Poulenc Rorer, Collegeville, PA.
6	Product Information. Normiflo (ardeparin). Wyeth-Ayerst Laboratories, Philadelphia, PA.
7	Product Information. Orgaran (danaparoid). Organon, West Orange, NJ.