Drug Reference
Cardiac
Alteplase (tPA)
Also: tPA, Activase
Fibrinolytic (tissue plasminogen activator)
IndicationAdult
StrokeAdult0.9 mg/kg (max 90 mg): 10% bolus over 1 min, remainder over 60 min
STEMIAdult15 mg bolus, 0.75 mg/kg over 30 min (max 50), 0.5 mg/kg over 60 min (max 35)
Massive PEAdult100 mg over 2 h; PE arrest: 50 mg bolus
Indications
- Acute ischemic stroke ≤ 4.5 h
- STEMI when PCI unavailable
- Massive PE / PE arrest
Contraindications & cautions
- Any prior ICH; ischemic stroke < 3 months
- Active bleeding; known intracranial neoplasm/AVM
- Suspected aortic dissection
- Stroke: BP > 185/110 that can't be lowered
Key pearls
- Tenecteplase 0.25 mg/kg (max 25 mg) single bolus is an alternative for stroke
- Orolingual angioedema, especially with ACE inhibitors