Alteplase
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Trade Name
Activase (primary brand name); generic alteplase. Also Cathflo Activase (for catheter clearance)
Classification
Thrombolytic agent; recombinant tissue plasminogen activator (tPA)
Dosage/Route
- * Dosage:
- – Vials: 50 mg, 100 mg (for reconstitution)
- – Cathflo: 2 mg vial
- * Route: Intravenous (IV) infusion or injection (bolus + infusion)
Usual Dosage
- * Acute Ischemic Stroke: 0.9 mg/kg IV (max 90 mg); 10% as bolus over 1 min, 90% infused over 60 min
- * Myocardial Infarction (MI): 100 mg total—15 mg IV bolus, 50 mg over 30 min, 35 mg over 60 min (accelerated regimen)
- * Pulmonary Embolism (PE): 100 mg IV over 2 hours
- * Cathflo (Catheter): 2 mg into catheter; dwell 30-120 min
- * Weight-based; adjust per protocol
Mechanism of Action
Binds to fibrin in clots, converting plasminogen to plasmin, which degrades fibrin and dissolves thrombi. Restores blood flow in occluded vessels (e.g., coronary, cerebral, pulmonary arteries)
Side Effects & Adverse Effects
- * Side Effects: Bleeding (minor; e.g., gums, injection site), fever
- * Adverse Effects:
- – Major hemorrhage (intracranial, GI; boxed warning)
- – Hypotension (during infusion)
- – Allergic reactions (rare; anaphylaxis, angioedema)
- – Reperfusion arrhythmias (post-MI)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor vital signs, neuro status (stroke), or ECG (MI) q15 min during/after infusion
- – Assess for bleeding (internal/external); avoid IM injections, invasive procedures
- – Use dedicated IV line; infuse via pump (no bolus push beyond protocol)
- – Stop if severe bleeding or neuro decline (e.g., ICH signs: headache, vomiting)
- * Teachings:
- – Report bleeding, bruising, or headache immediately
- – Expect bedrest during/after infusion (fall risk)
- – Avoid aspirin/NSAIDs post-treatment unless prescribed
- – Family: Watch for confusion, weakness (stroke recurrence)
Indication for This Patient
- * Acute ischemic stroke (within 3-4.5 hours of onset)
- * Acute myocardial infarction (MI) (STEMI, to restore coronary flow)
- * Massive pulmonary embolism (PE) (hemodynamic instability)
- * Central venous catheter occlusion (Cathflo)
Time
- * Timing:
- – Stroke: Start within 3-4.5 hours of symptom onset
- – MI: ASAP after diagnosis
- – PE: Over 2 hours
- * Infusion Time: Stroke: 60 min; MI: 90 min (accelerated); PE: 120 min
- * Onset: Clot lysis in minutes; full effect hours
