Alteplase

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  • Class of drug: Thrombolytic agent.
  • Mechanism of action: Converts fibrin-bound plasminogen to plasmin, which initiates local fibrinolysis (clot dissolution).
  • Indications/dosage/route: IV only.
  1. Acute myocardial infarction: accelerated infusion:
    Ð Adults weighing more than 65 kg: Infuse 15 mg over 1–2 minutes; infuse 50 mg over next 30 min. Begin heparin 5000–10,000 units IV bolus followed by continuous infusion of 1000 units/h. Infuse 35 mg alteplase over next hour.
  2. Acute ischemic stroke
  3. Pulmonary embolism
  • Contraindications:

Patients treated for acute MI, pulmonary embolism, active internal bleeding, history of cerebrovascular accident, recent intracranial or intraspinal surgery or trauma, intracranial neoplasm, arteriovenous malformation or aneurysm, known bleeding diathesis, severe uncontrolled bleeding, severe uncontrolled hypertension.

  • Warnings/precautions:
  1. Use with caution in patients with the following conditions:
    internal bleeding (intracranial, retroperitoneal, gastrointestinal, genitourinary, or respiratory tracts), superficial bleeding (venous cutdown sites, arterial punctures), recent major surgery (coronary artery bypass graft, obstetric delivery), cerebrovascular disease, mitral stenosis with atrial fibrillation, acute pericarditis, hemorrhagic ophthalmic conditions, concomitant administration of anticoagulants.
  2. Cardiac and blood pressure monitors are required when using this drug.
  3. Dose should be limited to 100 mg. Doses of 150 mg or greater have been shown to increase intracranial bleeding.
  4. Initiate therapy as soon as possible after stroke symptoms are apparent and no more than 3 hours after onset of stroke symptoms. After MI, therapy should be initiated within 7 hours.
  5. Obtain values for the following parameters before administering this drug: CBC, PT, PTT, creatinine phosphokinase, fibrinogen, cardiac isoenzymes.
  • Clinically important drug interactions:

The following drugs increase effects/toxicity of alteplase: warfarin, aspirin, ticlopidine, dipyridamole, heparin.

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