Alteplase
ACTIVASE
What it isRecombinant tissue plasminogen activator converting plasminogen to plasmin; acute ischemic stroke, STEMI and massive PE.
Why this oneIt dissolves clot that has already formed, which no anticoagulant does.
What limits it⚑ Benefit falls steeply after 4.5 hours in stroke. Intracranial hemorrhage is the price; screen every contraindication before use.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute ischemic stroke | Adults | 0.9 mg/kg IV (max 90 mg): 10% as bolus over 1 min, remainder over 60 min | 90 mg total | |
| Acute myocardial infarction | Adults | Weight-based (accelerated or 3-h regimen) | 100 mg total | |
| Acute massive pulmonary embolism | Adults | 100 mg IV over 2 h | 100 mg |
Renal Undefined
Hepatic Undefined
Instructions
- Give AIS within 3 hours of symptom onset; frequently monitor/control blood pressure
- Do not add other medications to Activase infusions
Contraindications
- Active internal bleeding
- Recent (within 3 months) intracranial/intraspinal surgery or serious head trauma
- Intracranial conditions that may increase bleeding risk (neoplasm, AVM, aneurysm)
- Bleeding diathesis
- Current severe uncontrolled hypertension
- AIS: current intracranial hemorrhage or subarachnoid hemorrhage
- AMI/PE: history of recent stroke
Cautions
- Bleeding (incl. intracranial hemorrhage)
- Hypersensitivity/angioedema
- Thromboembolism
- Cholesterol embolization
Adverse reactions
- Bleeding (most frequent, incl. intracranial hemorrhage)
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskIntracranial hemorrhage; the time window is everything
Classes and tags
Clinical profile
Mechanism of action: Alteplase ballicule
