Makindo Medical Notes

ℹ️ About

Always check the BNF link here 📖 for full prescribing advice.

• Alteplase is a potent thrombolytic agent used for STEMI, massive PE, and acute ischaemic stroke.

⚙️ Mode of Action

• Recombinant tissue plasminogen activator (tPA) → converts plasminogen to plasmin → breaks down fibrin clots 🩸.
• Plasma half-life: 4–8 minutes (so often given as bolus + infusion).

📏 Indications & Dose (check BNF / datasheet for details)

💡 Dosing regimens differ by indication → always double-check in BNF/local stroke/PE protocols.

⚠️ Interactions

• Other antithrombotics ↑ bleeding risk.
• Aspirin usually withheld for first 24 h post-stroke thrombolysis.

🔎 Cautions

• See BNF — specialist use only; ensure careful patient selection and imaging.

🚫 Contraindications

• Active bleeding, haemorrhagic stroke, aortic dissection.
• Recent major surgery or trauma, uncontrolled severe hypertension.
• Intracranial neoplasm, AV malformation, aneurysm.
• Active peptic ulcer, bleeding disorders, low platelets.
• Cavitating lung disease, heavy vaginal bleeding, anaemia suggesting occult bleeding.

❗ Side Effects

• Bleeding (major risk) 🩸.
• Hypotension → usually fluid responsive 💧.
• Anaphylaxis, angioedema, tongue swelling (↑ risk if on ACE inhibitors).
• Stroke conversion to haemorrhagic infarction.

📚 References

• BNF — Alteplase
• UK Stroke Guidelines / ESC STEMI Guidelines