Alteplase: Difference between revisions

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==Administration==
==Administration==
*Type: [[Thrombolytic]]
*Type: [[Thrombolytic]]
*Dosage Forms:
*Dosage Forms: powder for injection (reconstitute before use)
*Routes of Administration: IV
*Routes of Administration: IV
*Common Trade Names: tPA
*Common Trade Names: tPA


==Adult Dosing==
==Adult Dosing==
*Acute [[MI]]:
===Acute [[MI]]===
**>67kg: 15mg IV over 1-2min; then 50mg IV over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
*>67kg: 15mg IV over 1-2min; then 50mg IV over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
**≤67kg: 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) IV over 30 min; then 0.5 mg/kg over 60min (max 35 mg)
*≤67kg: 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) IV over 30 min; then 0.5 mg/kg over 60min (max 35 mg)
*Acute [[ischemic stroke]]:
 
**0.9mg/kg IV (max 90mg total)
===[[Thrombolytics for acute ischemic stroke|Acute ischemic stroke]]===
***10% of dose is administered as bolus; rest is given over 60min
*0.9mg/kg IV (max 90mg total)
*Massive [[PE]]::
**10% of dose is administered as bolus; rest is given over 60 minutes
**100mg IV over 2hr OR 0.6mg/kg over 2min
 
**See also: [[EBQ:Thrombolysis in Pulmonary Embolism Metanalysis]]
===[[Thrombolytics for pulmonary embolism|Massive PE]]===
*Arterial thrombosis:
*Stable Massive PE: 100mg IV over 2 hr '''OR''' 0.6mg/kg over 2 min
**1.5 mg/hour by transcatheter intra-arterial infusion until lysis of thrombus
*Cardiac arrest: 50mg IV over 2 min followed by 50mg IV after 15 min if needed
 
===Arterial thrombosis===
*1.5 mg/hour by transcatheter intra-arterial infusion until lysis of thrombus


==Pediatric Dosing==
==Pediatric Dosing==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Bleeding!
*Intracranial hemorrhage - see [[Post-tPA Hemorrhage in CVA]]
*GI bleed
*GI bleed
*Pericardial effusion, pericarditis, cardiac tamponade
*Pericardial effusion, pericarditis, cardiac tamponade
*Intracranial hemorrhage, cerebral herniation
*Stroke, seizure
*Stroke, seizure
*Anaphylaxis, angioedema
*Pulmonary edema, pleural effusion
*Pulmonary edema, pleural effusion
*Cardiac dysrhythmia
*Cardiac dysrhythmia
*Anaphylaxis or angioedema
**Stop tPA immediately
**Epinephrine 0.3 mg IM
**Famotidine 40 mg IV
**Diphenhydramine 50 mg IV
**Methylprednisolone 125 mg IV
**Consider early airway management PRN
===Common===
===Common===


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==References==
==References==
<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:Cardiology]] [[Category:Vascular]] [[Category:Neurology]]

Latest revision as of 11:38, 6 May 2020

Administration

  • Type: Thrombolytic
  • Dosage Forms: powder for injection (reconstitute before use)
  • Routes of Administration: IV
  • Common Trade Names: tPA

Adult Dosing

Acute MI

  • >67kg: 15mg IV over 1-2min; then 50mg IV over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
  • ≤67kg: 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) IV over 30 min; then 0.5 mg/kg over 60min (max 35 mg)

Acute ischemic stroke

  • 0.9mg/kg IV (max 90mg total)
    • 10% of dose is administered as bolus; rest is given over 60 minutes

Massive PE

  • Stable Massive PE: 100mg IV over 2 hr OR 0.6mg/kg over 2 min
  • Cardiac arrest: 50mg IV over 2 min followed by 50mg IV after 15 min if needed

Arterial thrombosis

  • 1.5 mg/hour by transcatheter intra-arterial infusion until lysis of thrombus

Pediatric Dosing

  • PE: 0.5 mg/kg/hour IV, for a maximum of 6 hours, in addition to heparin

Special Populations

Contraindications

  • Allergy to class/drug
  • Bleeding diathesis
  • Active internal bleeding
  • Current intracranial hemorrhage, subarachnoid hemorrhage
  • Intracranial neoplasm, arteriovenous malformation, aneurysm, or other conditions that may increase the risk of intracranial bleeding
  • Recent (<3 mo) intracranial or intraspinal surgery
  • Recent (<3 mo) serious head trauma
  • Recent (<3 mo) stroke (for patients being treated for MI or PE)
  • Severe uncontrolled hypertension

Adverse Reactions

Serious

  • Intracranial hemorrhage - see Post-tPA Hemorrhage in CVA
  • GI bleed
  • Pericardial effusion, pericarditis, cardiac tamponade
  • Stroke, seizure
  • Pulmonary edema, pleural effusion
  • Cardiac dysrhythmia
  • Anaphylaxis or angioedema
    • Stop tPA immediately
    • Epinephrine 0.3 mg IM
    • Famotidine 40 mg IV
    • Diphenhydramine 50 mg IV
    • Methylprednisolone 125 mg IV
    • Consider early airway management PRN

Common

Pharmacology

  • Onset of action: 30-60 minutes
  • Half-life: 26.5 to 46 minutes
  • Metabolism: Liver
  • Excretion:

Mechanism of Action

  • Tissue plasminogen activator (TPA): binds fibrin, enhances conversion of plasminogen to plasmin thus initiating fibrinolysis

Comments

See Also

References

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