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Alteplase(rTPA, Activase) Class
Alteplase(rTPA, Activase) Mech
- An enzyme that converts plasminogen to the enzyme plasmin
- Produces a limited amount of fibrinogen in the absence of fibrin.
- Binds to fibrin in a clot and converts the plaminogen into plasmin. Plasmin then digests the fibrin and fibrinogen causing the clot(s) to dissolve.
Alteplase(rTPA, Activase) Indication
- Acute coronary syndrome (ACS)
- Acute ischemic stroke (CVA)
Alteplase(rTPA, Activase) Contra
- Absolute:Any prior intracranial hemorrhage
- Known structual cerebral vascular lesion
- Known malignant intracranial neoplasm
- Ischemic stroke within 3 months(EXCEPT acute ischemic stroke within 3hrs)
- Suspected aortic aneurysm
- Active bleeding or bleeding disorder(excluding menses)
- Significant closed head or facial trauma within 3 months
- History of chronic, severe or uncontrolled hypertension
- Severe uncontrolled hypertension on presentation(SBP>180mmHg or DPB>110mmHG)
- History of prior ischemic stroke >3months
- Dementia; or other known intracranial pathology not specifically covered in the contraindications
- Traumatic or prolonged CPR(>10mins)
- Major surgery(<3 weeks)
- Recent internal bleeding (within 2-4 weeks)
- Noncompressible vascular punctures
- Active peptic ulcers
- Current use of anticoagulants
Alteplase(rTPA, Activase) Adverse
- Allergic reactions and or anaphylaxis(rare)
Alteplase(rTPA, Activase) Dosage
Adult: Total dose is 100mg. Loading dose of 15mg is administered as an IV bolus over 1-2mins. Followed with an infusion of 0.75mg/kg(up to 50mg)IV over 30mins. Then an infusion of 0.5mg/kg(up to 35mg)IV over 60mins. Infusions must be administered via pump and be carefully monitored.
Peds: Not recommended