Alteplase: Difference between revisions
(added dosage form) |
|||
| Line 6: | Line 6: | ||
==Adult Dosing== | ==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 60min | |||
===Massive [[PE]]=== | |||
*100mg IV over 2hr '''OR''' 0.6mg/kg over 2min | |||
*See also: [[EBQ:Thrombolysis in Pulmonary Embolism Metanalysis]] | |||
===Arterial thrombosis=== | |||
*1.5 mg/hour by transcatheter intra-arterial infusion until lysis of thrombus | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
Revision as of 06:07, 5 March 2019
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 60min
Massive PE
- 100mg IV over 2hr OR 0.6mg/kg over 2min
- See also: EBQ:Thrombolysis in Pulmonary Embolism Metanalysis
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
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: not defined
- Hepatic dosing: not defined
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
- Bleeding!
- GI bleed
- Pericardial effusion, pericarditis, cardiac tamponade
- Intracranial hemorrhage, cerebral herniation
- Stroke, seizure
- Anaphylaxis, angioedema
- Pulmonary edema, pleural effusion
- Cardiac dysrhythmia
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
- Thrombolytics
- Thrombolysis in Acute Ischemic Stroke (tPA)
- EBQ:Thrombolysis in Pulmonary Embolism Metanalysis
- Acute arterial ischemia
- STEMI