Drug General Information (ID: DDIFM5JYIW)
Drug Name			Alteplase		Drug Info		Salsalate		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Thrombolytics				Antiinflammatory Agents

Mechanism of Alteplase-Salsalate Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Alteplase				Salsalate
Mechanism		Risk of bleeding Thrombolytic agent				Risk of bleeding Antiplatelet effects
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 Salsalate

Recommended Action
Management		Careful monitoring for signs of bleeding, particularly at arterial puncture wounds, is recommended when thrombolytics are used concurrently or sequentially with antiplatelet agents other than aspirin. Some authorities recommend avoiding the initiation of platelet aggregation inhibitors within the first 24 hours following thrombolysis treatment.

References
1	Harder S, Klinkhardt U "Thrombolytics: drug interactions of clinical significance." Drug Saf 23 (2000): 391-9. [PMID: 11085346]
2	Hirsch J, Dalen J, Guyatt G, American College of Chest Physicians "The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Physicians." Chest 119(1 Suppl) (2001): 1S-2S. [PMID: 11157638]
3	Product Information. Abbokinase (urokinase). Abbott Pharmaceutical, Abbott Park, IL.
4	Product Information. Activase (alteplase). Genentech, South San Francisco, CA.
5	Product Information. Retavase (reteplase). Boehringer Mannheim, Gaithersburg, MD.
6	Product Information. Streptase (streptokinase). Astra USA, Westborough, MA.
7	Product Information. Ticlid (ticlopidine). Syntex Laboratories Inc, Palo Alto, CA.
8	Product Information. TNKase (tenecteplase) Genentech, South San Francisco, CA.