Bleeding is the major complication of thrombolytic therapy. Less common complications include fever, embolization of thrombi, and allergic reactions. Bleeding complications are primarily due to the dissolution of hemostatic plugs at sites of recent vascular injury. Superficial bleeding is usually not a major problem and can be controlled with local measures. Thrombolytic agents are discontinued at the first indication of major bleeding. Although the half-life of the thrombolytics is short, the systemic fibrinolytic state remains for 12 to 36 h after the infusion is stopped because it takes that long for fibrinogen to replenish itself. Cryoprecipitate can be given to replete fibrinogen and reverse the lytic state. EACA can also be given to inhibit the fibrinolytic state.
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