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Alteplase

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Anaesthetics and Critical Care

Obstetrics Gynaecology

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Urology

Version Jan 2023

About : Always check the BNF link here

Potent thrombolytic agent

Mode of action

Plasminogen activator breaks down fibrin clots
Plasma half-life of 4-8 min

Dose range:You must check with BNF or drug datasheet

Name	Starting Dose	Frequency	Route
Alteplase (PE)	Alteplase 10 mg over 2 min Alteplase 90 mg over 2 h (Max 1.5 mg/kg for those weighing <65 kg.)	OD	PO
Alteplase (STEMI within 6 h of symptoms onset Wt < 65 kg)	Alteplase 15 mg IV bolus Alteplase 0.75 mg/kg (max 50 mg) IV over 30 min Alteplase 0.5 mg/kg (max 35 mg) IV over 60 min. Max dose 100 mg	OD	PO
Alteplase (STEMI within 6 h of symptoms onset Wt > 65 kg)	Alteplase 15 mg IV bolus Alteplase 50 mg IV over 30 min Alteplase 35 mg IV over 60 min.	OD	PO
Alteplase (STEMI within 6-12 hrs of symptoms onset Wt > 65 kg)	Alteplase 10 mg IV bolus Alteplase 50 mg IV over 60 min Alteplase 10 mg IV over 30 min x 4 (total dose 100 mg over 3 hrs)	OD	PO
Alteplase (Ischaemic stroke) within 4.5 hrs	Alteplase 0.9 mg/kg (max dose 90 mg) with Alteplase 10% bolus Alteplase 90% over 60 min.	OD	PO

Interactions

Other antithrombotics increase bleeding risk.
Aspirin withheld for 24 hrs

Cautions

See BNF

Contraindications

Anaphylaxis, active bleeding, anticoagulation, varices, aortic dissection
Cavitating lung disease, heavy vaginal bleeding, stroke disease (take specialist advice), Active peptic ulcer disease
Anaemia suggesting occult bleeding, recent surgery, recent trauma
Severe hypertension, pericarditis, any haemorrhagic stroke
Active bleeding, trauma, malignancy.

Side effects

Low BP, bleeding; mild low BP may need IV fluids and leg raising, bleeding
Anaphylaxis, angioneurotic oedema, tongue swelling with alteplase especially if on ACEI.

References

Alteplase in BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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