THERAPEUTICS

Brands

• Activase, Cathflo Activase

Generic?

• Yes

Class

• Thrombolytic agent

Commonly Prescribed for

(FDA approved in bold)

• Acute ischemic stroke (AIS)

• Acute myocardial infarction (AMI)

• Pulmonary embolism (PE)

• Restoration of function to central venous access device

How the Drug Works

• Alteplase is a tissue plasminogen activator (tPA). It binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin, initiating a local fibrinolysis with little systemic effect

How Long Until It Works

• Less than 1 hour, often earlier

If It Works

• After administration, monitor in intensive care – preferably in an acute stroke or cardiac unit

If It Doesn't Work

• Alteplase is not always effective and has risks. After initial monitoring period in intensive care, continue standard AIS, AMI, or PE care

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Alteplase with heparin may improve the clinical course of PE

Tests

• Ensure no contraindications are present before administering drug. For all patients with suspected AIS with onset less than 3 hours prior, immediately type and screen, obtain CBC, glucose, coagulation tests, and ensure no intracranial bleeding (usually with head CT)

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Activating plasminogen increases bleeding risk

Notable AEs

• Superficial bleeding (e.g., at puncture sites), fever, hypotension, dyspnea, nausea, urticaria, and flushing

Life-Threatening or Dangerous AEs

• Internal bleeding (intracranial, GI, GU, or retroperitoneal), anaphylactic reaction, reperfusion arrhythmias, and thrombocytopenia

Weight Gain

• Unusual

Sedation

• Unusual

What to Do About AEs

• Stop infusion for any serious bleeding. Can use fresh frozen plasma if needed

Best Augmenting Agents to Reduce AEs

• Most AEs cannot be reduced by an augmenting agent

DOSING AND USE

Usual Dosage Range

• 90 mg or less for AIS, 100 mg or less for AMI or PE

Dosage Forms

• Lyophilized powder for injection: 2 mg in 2 mL, 50 mg in 50 mL, 100 mg in 100 mL