{"pk":761,"title":"Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid","subtitle":null,"abstract":"Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA’s fibrinolytic effects.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7zt8c7w3","frozenauthors":[{"first_name":"Cynthia","middle_name":"","last_name":"Romero","name_suffix":"","institution":"Emory University Hospital, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Samuel","middle_name":"","last_name":"Shartar","name_suffix":"","institution":"Emory University Hospital, Department of Emergency Medicine, Atlanta, Georgia; Emory University Hospital, Office of Critical Event Preparedness and Response, Atlanta, Georgia","department":"None"},{"first_name":"Michael","middle_name":"J.","last_name":"Carr","name_suffix":"","institution":"Emory University Hospital, Department of Emergency Medicine, Atlanta, Georgia","department":"None"}],"date_submitted":"2019-12-17T23:25:11+02:00","date_accepted":"2019-12-17T23:25:11+02:00","date_published":"2020-01-04T11:36:55+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/761/galley/516/download/"}]}