Generic Name and Formulations:
Alteplase 50mg, 100mg; per vial; lyophilized pwd for IV infusion after reconstitution and dilution.
Treatment of acute myocardial infarction (AMI) to reduce mortality and incidence of heart failure. Treatment of acute ischemic stroke. Treatment of acute massive pulmonary embolism (PE) for lysis.
The risk of stroke may outweigh the benefit of thrombolytic therapy in patients whose AMI puts them at low risk for death or heart failure.
AMI: Max total dose: 100mg. Accelerated infusion: ≤67kg: 15mg IV bolus followed by 0.75mg/kg (max 50mg) infused over 30min, then 0.5mg/kg (max 35mg) over 60min. >67kg: 15mg IV bolus followed by 50mg infused over 30min, then 35mg infused over 60min. 3-hour infusion: (≥65kg): 60mg infused in the first hour (of which 6–10mg is given as bolus), then 20mg/hr for 2hrs; (<65kg): 1.25mg/kg over 3hrs (of which 0.075mg/kg as bolus, 0.675mg/kg for the rest of the first hour, then 0.25mg/kg/hr for 2hrs). Stroke: start treatment within 3hrs of symptom onset. 0.9mg/kg (max 90mg total dose) infused over 60min with 10% of the total dose given as an initial IV bolus over 1 minute. Monitor frequently and control blood pressure. PE: 100mg infused over 2hrs. Heparin may be used concomitantly in MI or after infusion in PE.
AMI and PE: History of recent stroke. Stroke: Intracranial or subarachnoid hemorrhage. All: Active internal bleeding. Intracranial or intraspinal surgery or serious head trauma within 3 months. Intracranial neoplasm, arteriovenous malformation or aneurysm. Bleeding diathesis. Current severe uncontrolled hypertension.
Stroke: treatment >3hrs after symptom onset not recommended. Avoid IM inj and trauma to the patient while on therapy. Increased bleeding risk at puncture sites (eg, arterial, internal jugular, subclavian venous); avoid. Discontinue if serious bleeding occurs, if INR >1.7, or activated partial thromboplastin time is elevated. Increased risk of complications with recent major surgery, intracranial hemorrhage, GI or GU bleeding, or trauma, cerebrovascular disease, hypertension (systolic BP >175mm Hg and/or diastolic BP >110mm Hg), acute pericarditis, subacute bacterial endocarditis, hemostatic defects, hepatic dysfunction, pregnancy, hemorrhagic ophthalmic conditions, septic thrombophlebitis or occluded AV cannula, elderly. Increased risk of thromboembolism in left heart thrombus (eg, mitral stenosis, A-fib). PE: consider possible risk of reembolization due to lysis of underlying deep venous thrombi. Avoid extravasation. Pregnancy. Nursing mothers.
Tissue plasminogen activator (tPA).
Increased risk of bleeding with anticoagulants, antiplatelets. Angioedema risk with ACEI; monitor; discontinue if occurs. May interfere with coagulation tests.
Bleeding (may be fatal), hypersensitivity reactions (eg, anaphylactoid, angioedema, urticaria, laryngeal edema, rash, shock; monitor and discontinue if occurs); rare: cholesterol embolism.
Vials—1 (w. diluent)
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