From the FDA Drug Label
4 CONTRAINDICATIONS
TNKase is contraindicated in patients with [see Warnings and Precautions (5.1)]: Active internal bleeding History of cerebrovascular accident Intracranial or intraspinal surgery or trauma within 2 months Intracranial neoplasm, arteriovenous malformation, or aneurysm Known bleeding diathesis Severe uncontrolled hypertension
The use of abixaban is not mentioned as a contraindication for TNK in the provided drug label 1.
- The listed contraindications include active internal bleeding, history of cerebrovascular accident, and others, but do not explicitly mention abixaban.
- Therefore, based on the provided information, being on abixaban is not directly stated as a contraindication for TNK.
From the Research
Being on apixaban is generally considered a relative contraindication for TNK, not an absolute one, as it increases the risk of bleeding complications, and the decision to use TNK requires careful risk-benefit assessment 2. In acute situations such as ST-elevation myocardial infarction or massive pulmonary embolism where TNK might be indicated, the increased bleeding risk must be weighed against the potential benefit of thrombolysis. The mechanism behind this contraindication relates to the combined anticoagulant effects - apixaban inhibits factor Xa while TNK dissolves existing clots, potentially creating a dangerous level of anticoagulation. Key considerations include:
- The timing of the last apixaban dose, as the bleeding risk is higher if TNK is administered shortly after an apixaban dose.
- Closer monitoring for bleeding complications is essential if TNK is deemed necessary despite apixaban use.
- Alternative approaches, such as primary percutaneous coronary intervention for STEMI, might be preferred over thrombolysis in patients on apixaban, especially considering the findings of a recent study that extended anticoagulation with reduced-dose apixaban was noninferior to full-dose apixaban for the prevention of recurrent venous thromboembolism in patients with active cancer, and led to a lower incidence of clinically relevant bleeding complications 2. It's also worth noting that apixaban has been shown to be effective in treating venous thromboembolism with a lower risk of major bleeding compared to traditional anticoagulants, such as warfarin 3, and its use should be carefully managed to minimize the risk of bleeding complications when considering thrombolytic therapy like TNK.