💉 Reteplase is a fibrinolytic agent used in acute STEMI. ⚠️ A bolus intravenous injection of unfractionated Heparin should be given before the first dose, and the cannula flushed well with saline OR a separate cannula should be used, as reteplase and heparin are physically incompatible.

📖 About

Belongs to the fibrinolytic class of drugs.
Licensed specifically for acute STEMI within 12 hours of onset.
Always check the BNF link here for the most up-to-date UK prescribing advice.

⚙️ Mode of Action

Recombinant plasminogen activator.
Activates endogenous tissue plasminogen → converts plasminogen to plasmin → breaks down fibrin within thrombi.
Restores coronary artery patency and limits infarct size if given early.

🩺 Indications

ST-Elevation Myocardial Infarction (STEMI): within 12 hours of symptom onset if PCI is not immediately available.

💊 Dose

First dose: 10 units (≈10 mg) IV bolus over 2 minutes. Flush line before and after.
Second dose: 10 units IV bolus over 2 minutes, given 30 minutes after the first. Flush before and after.
Always co-administer with heparin and aspirin (unless contraindicated).

🔗 Interactions

⬆️ Risk of bleeding with other anticoagulants (e.g., heparin, warfarin) or antiplatelets (aspirin, clopidogrel, GPIIb/IIIa inhibitors).

🚫 Absolute Contraindications

Prior intracranial haemorrhage at any time.
Ischaemic stroke within 3 months (unless acute ischaemic stroke within 4.5h, where thrombolysis is indicated).
Intracranial neoplasm, AV malformation, or aneurysm.
Active bleeding diathesis or uncontrolled haemorrhage.
Significant closed-head or facial trauma within 3 months.
Uncontrolled hypertension (systolic >180 or diastolic >100 mmHg).
Dissecting aortic aneurysm.
Recent major intracranial or intraspinal surgery.

⚠️ Relative Contraindications (seek senior advice)

Recent GI or other bleeding.
Rigorous CPR >10 minutes.
Active peptic ulceration.
Pregnancy, post-partum, or active menstruation.
Therapeutic anticoagulation (e.g., warfarin).
Known cancer (esp. with bleeding risk).
Diabetic or haemorrhagic retinopathy.
Recent invasive or surgical procedure (within 3 weeks).

⚡ Side Effects

Major bleeding (intracranial or GI haemorrhage).
Anaphylaxis or allergic reaction (rare).
Angioedema.
Reperfusion arrhythmias (often a marker of coronary reperfusion).

💡 Clinical Pearls

✔️ Reteplase is given as two bolus injections (not a prolonged infusion like alteplase). ✔️ Works best if given within 2–3 hours of symptom onset. ✔️ Always combine with dual antiplatelet therapy + anticoagulation unless contraindicated. ✔️ Watch closely for bleeding and reperfusion arrhythmias — may require immediate defibrillation.

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Reteplase