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Alteplase
Related Subjects: |Hypertension |Cardiac Thrombolysis |Stroke Thrombolysis |Alteplase |Tenecteplase |Streptokinase |Reteplase
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)
| Indication | Dose | Route |
|---|---|---|
| Massive PE (with haemodynamic instability) | 10 mg IV bolus over 2 min, followed by 90 mg IV infusion over 2 h (max 1.5 mg/kg if <65 kg) | IV |
| STEMI (≤ 6 h, weight <65 kg) | 15 mg IV bolus → 0.75 mg/kg (max 50 mg) IV over 30 min → 0.5 mg/kg (max 35 mg) IV over 60 min (max total 100 mg) | IV |
| STEMI (≤ 6 h, weight ≥65 kg) | 15 mg IV bolus → 50 mg IV over 30 min → 35 mg IV over 60 min (max total 100 mg) | IV |
| STEMI (6–12 h, weight ≥65 kg) | 10 mg IV bolus → 50 mg IV over 60 min → 10 mg IV q30min ×4 (total 100 mg over 3 h) | IV |
| Ischaemic stroke (≤ 4.5 h of onset) | 0.9 mg/kg (max 90 mg): 10% as IV bolus, 90% IV infusion over 60 min | IV |
💡 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
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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