Alteplase

Administration

• Type: Thrombolytic
• Dosage Forms:
• 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

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

See Also

• Thrombolytics
• Thrombolysis in Acute Ischemic Stroke (tPA)
• EBQ:Thrombolysis in Pulmonary Embolism Metanalysis
• Acute arterial ischemia
• STEMI