Alteplase

About these monographs

Category:

Cardiac and Vascular

 

Description:

Fibrinolytic and Tissue Plasminogen Activator (tPA)

Indications:

Acute coronary syndrome, acute ischaemic stroke, and acute massive pulmonary embolism

Mechanism of Action:

The enzyme tPA converts plasminogen to the enzyme plasmin. Plasmin digests fibrin and fibrinogen,

dissolving clots.

Pharmacokinetics:

Onset: 5-10 minutes

Peak Effects: 510 minutes

Duration: variable

Contraindications:

Most paramedics who administer this medication will have a 'fibrinolytic checklist' they must review prior to administration.  Follow your local service clinical practice guidelines.

Adverse Effects:

Bleeding, hypersensitivity, anaphylaxis, hypotension, dysrhythmias, cerebral oedema (CVA), nausea and

vomiting, hyperthermia, myocardial reinfarction, pulmonary re-embolism, new ischaemic stroke

Precautions and Facts:

Minimise arterial/venous punctures if considering the administration of tPA. Avoid IMI and non-essential patient

handling. Angioedema is a risk up to 24 hours post infusion. Patients taking ACE inhibitors are at increased risk of an allergic reaction including angioedema and anaphylaxis. Patient aged > 80 years may be at risk of poorer outcomes.

Presentation:

10 or 50 mg vial to be reconstituted with 10 or 50 mL of sterile water

Dosages (adult only)

Indication: ACUTE CORONARY SYNDROME

Route: IV

Initial Dose: 10 mg bolus

Dose Intervals: Follow with 50 mg infusion over 1 hour and then 40 mg over the next 2 hours

Volume/Dilution: 10 mg in 10 mL or 50 mg in 50 mL

Maximum Dose: 1.5 mg/kg if patient weighs < 65 kg.

Indication: PULMONARY EMBOLISM

Route: IV

Initial Dose: 10 mg bolus

Dose Intervals: Follow with 90 mg infusion over 2 hours

Volume/Dilution: 10 mg in 10 mL or 50 mg in 50 mL

Maximum Dose: 1.5 mg/kg if patient weighs < 65 kg.

Indication: ACUTE ISCHAEMIC STROKE

Route: IV

Initial Dose: 0.1 mg/kg bolus started within 4.5 hours of symptom onset

Dose Intervals: Follow with 0.8 mg/kg over the next 60 mins

Volume/Dilution: 10 mg in 10 mL or 50 mg in 50 mL

Maximum Dose: 90 mg

Cite as: Maria, S., Colbeck, M., & Caffey, M. (Eds.). (2020). Alteplase. In Paramedic & Emergency Pharmacology Guidelines (2nd ed.). Melbourne, Victoria: Pearson.

This book is for information purposes only and is designed as a general reference for paramedics, students and healthcare professionals  No responsibility will be taken for inaccuracies, omissions or errors  The authors do not accept liability to any person or organization for the information that may result in loss or damages incurred as a result of reliance upon the material in this guide While every effort has been made to ensure that the information in this text is up to date, accurate and in accordance with current clinical recommendations and practice, the dynamic nature of healthcare and pharmaceutical information requires any student or health professional to exercise independent clinical judgement when referring, using or providing information from this book

 

A body of evidence for the development of this guide has been collected by the authors to support the pharmacokinetics, indication, contraindications, adverse effects and dosage behind each medication  This body reflects information provided by Australia’s Therapeutic Goods Administration, Monthly Index of Medical Specialities, the United States’ Food and Drug Administration, and both peer-reviewed studies and clinical trials demonstrating the approved efficacy, usage and current understanding of each medication  Additionally, the Australian Resuscitation Council guidelines and each state ambulance service’s clinical practice guidelines in Australia and New Zealand were reviewed and applied in order to maximize the clinical application of this reference guide  Lastly, this guide’s information is not endorsed, nor does it reflect preferences by any particular pharmaceutical company or ambulance service as this reference was compiled only to the most current and universal information available from the above listed, publicly available resources

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