Adult Dosing
Acute myocardial infarction
Note: Administer second dose 30 mins after first dose
Pulmonary embolism [Non-FDA Approved]
- 10 U IV bolus initially, with a second bolus at 30 minutes
Acute Coronary Syndromes [Non-FDA Approved]
- 10 U IV bolus followed by further 10 U IV bolus 30 mins later
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Bleeding is associated with this therapy. Both internal bleeding and superficial bleeding sites may be involved. Avoid concomitant use with heparin anticoagulants. Carefully monitor all potential bleeding sites (including catheter insertion sites, arterial and venous puncture sites, cutdown sites, and needle puncture sites). Avoid noncompressible arterial puncture and internal jugular and subclavian venous punctures to minimize bleeding from noncompressible sites. Preferably use an upper extremity vessel that is accessible to manual compression should an arterial puncture is essential. Apply pressure for at least 30 minutes, apply a pressure dressing and frequently check the puncture site for evidence of bleeding. Avoid IM injections and nonessential handling of the patient. Carefully perform venipunctures and only as required. Immediately terminate concomitant anticoagulant therapy on occurrence of serious bleeding not controllable by local pressure. Avoid administration of second bolus if bleeding occurs before administration of this dose
- Risk of therapy may be increased in the presence of recent major surgery, e.g., coronary artery bypass graft, obstetrical delivery, organ biopsy, previous puncture of noncompressible vessels, cerebrovascular disease, recent gastrointestinal or genitourinary bleeding, recent trauma, hypertension: systolic BP 180 mm hg and/or diastolic BP 110 mm hg, high likelihood of left heart thrombus, e.g., mitral stenosis with atrial fibrillation, acute pericarditis, subacute bacterial endocarditis, hemostatic defects including those secondary to severe hepatic or renal disease, severe hepatic or renal dysfunction, pregnancy, diabetic hemorrhagic retinopathy or other hemorrhagic ophthalmic conditions, septic thrombophlebitis or occluded AV cannula at a seriously infected site, advanced age, patients currently receiving oral anticoagulants, e.g., warfarin sodium, condition in which bleeding constitutes a significant hazard or would be particularly difficult to manage because of its location
- Cholesterol embolization associated with invasive vascular procedures may occur
- Arrhythmias associated with reperfusion may occur on development of coronary thrombolysis under standard antiarrhythmic measures for proper management of this condition. Keep ready antiarrhythmic therapy for bradycardia and/or ventricular irritability when this drug is administered
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Hypertension
- Pericarditis
- LV thrombus
- Hemostatic disorder
- Hemorrhagic retinopathy
- Septic thrombophlebitis
- Occluded AV cannula
- Recent major surgery
- Recent trauma
- Cerebrovascular disease
- Recent GI bleeding
- Recent GU bleeding
- Recent use of GP IIb/IIIa inhibitor
- Use of anticoagulant
- Geriatrics
Pregnancy Category:C
Breastfeeding: Safety unknown; manufacturer advises caution.
