Hemorrhagic Upper Extremity Complications From Tissue Plasminogen Activator

Five patients, ages 63 to 79, had hemorrhagic complications involving the upper extremity from
fibrinolytic therapy using intravenous tissue plasminogen activator (tPA) for acute myocardial infarction. The hemorrhages varied in severity. Three patients were treated for superficial hematomas, one with a deep subcutaneous hematoma producing skin necrosis, and one compartment syndrome with posterior interosseous nerve palsy and marked intramuscular bleeding. tPA is currently being used in the treatment of acute myocardial infarction and acute nonhemorrhagic stroke. Caution should be used particularly for IV sites, central lines, arterial catheterization, and pneumatic tourniquets, to avoid upper extremity hemorrhage. (Journal of Surgical Orthopaedic Advances 16(1):27–30, 2007)