Drug interactions
Alteplase + Bivalirudin
Severity: Major
Alteplase and Bivalirudin: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both agents impair clot formation or dissolve clots, so combined use raises the risk of major bleeding. Bivalirudin is sometimes used around thrombolysis but requires careful oversight.
What this interaction means in plain words
Alteplase and Bivalirudin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Direct thrombin inhibition combined with plasminogen activation gives additive bleeding risk.
What to do
Monitor for bleeding and ACT or aPTT, and avoid invasive procedures. Reserve concurrent use for clear indications.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Alteplase
- Alteplase + Defibrotide Contraindicated
- Alteplase + Reteplase Contraindicated
- Alteplase + Tenecteplase Contraindicated
- Acetylsalicylic acid + Alteplase Major
- Alteplase + Apixaban Major
- Alteplase + Argatroban Major
Frequently asked questions
Can I take Alteplase with Bivalirudin?
MediHelp rates the interaction as major. Alteplase and Bivalirudin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both agents impair clot formation or dissolve clots, so combined use raises the risk of major bleeding. Bivalirudin is sometimes used around thrombolysis but requires careful oversight.
How serious is the interaction between Alteplase and Bivalirudin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for bleeding and ACT or aPTT, and avoid invasive procedures. Reserve concurrent use for clear indications.
What other medicines interact with Alteplase?
MediHelp also lists interactions of Alteplase with, for example, Defibrotide, Reteplase, Tenecteplase. The full list is on the Alteplase page.
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