title: Fatal Intraperitoneal Bleeding after Intravenous Administration of Tissue Plasminogen Activator.
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.
authors.affiliation: Department of Neurology, Nagoya City East Medical Center, Nagoya, Japan. Electronic address: thingswillgomyway@yahoo.co.jp.
authors.forename: Chise
authors.initials: C
authors.lastname: Anan
authors.affiliation: Department of Neurology, Nagoya City East Medical Center, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oomura
authors.affiliation: Department of Cardiology, Nagoya City East Medical Center, Nagoya, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Saeki
authors.affiliation: Department of Neurology, Nagoya City East Medical Center, Nagoya, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Neurology, Nagoya City East Medical Center, Nagoya, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Sato
authors.affiliation: Department of Neurology, Nagoya City East Medical Center, Nagoya, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
mesh_terms: D000369:Aged, 80 and over; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy*; D007262:Infusions, Intravenous; D018810:Magnetic Resonance Angiography; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Cerebral infarction; intraperitoneal hemorrhage; rt-PA; thrombolytic therapy