Adult Dosing
Activase
Acute myocardial infarction
- Accelerated infusion
- <67 kg: 15 mg IV bolus; followed by 0.75 mg/kg (max: 50 mg) infused over next 30 mins; then 0.5 mg/kg (Max: 35 mg) infused over next 60 mins
- >67 kg: 15 mg IV bolus; followed by 50 mg infused over next 30 mins; then 35 mg (0.5 mg/kg) infused over next 60 min
- 3-Hour Infusion
- <65 kg: 1.25 mg/kg over 3 hrs; (60 % in first hr, 6-10% given as a bolus, 20% over the 2nd hr, and 20% mg/kg over the 3rd hr)
- >65 kg: 60 mg over 1st hr (6-10 mg given as a bolus ), 20 mg over the 2nd hr, and 20 mg over the 3rd hr for a total dose of 100 mg
Acute pulmonary embolism
- 100 mg IV infusion over 2 hrs
- Start heparin at or near end of alteplase when a PTT or thrombin time returns to twice normal value or less
Acute ischemic thrombotic stroke
- 0.9 mg/kg IV infused over 1 hr (10% of total dose as bolus over 1 min) [Max:90 mg]
Cathflo Activase
Occluded central venous IV catheter clearance
30 kg: 2 mg/2 mL instilled into occluded catheter; if unsuccessful, may repeat once after 2 hrs- <30 kg: 110% of the lumen volume (not to exceed 2 mg in 2 mL) instilled into occluded catheter; if unsuccessful, may repeat once after 2 hrs
Acute Coronary Syndromes [Non-FDA Approved]
- 15 mg IV bolus followed by 0.75 mg/kg (Max 50 mg) over 30 mins, then 0.5mg/kg (Max 35 mg) over the next 60 mins
Thrombolytic therapy for Frostbite [Non-FDA Approved]
- 0.5-1 mg/hr into the extremity via the femoral or brachial arterial catheter sheath for a period of 8-48 hrs depending on response to therapy seen on angiograms
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Alteplase therapy can cause internal bleeding (intracranial, gastrointestinal, retroperitonial, genitourinary or respiratory) or superficial or surface bleeding. Monitor the patients and terminate the therapy immediately if any sign and symptom bleeding occurs
- Carefully evaluated and anticipated benefits weighed against potential risks associated with therapy before considering alteplase therapy in any patient
- Cholesterol embolism causing “purple toe” syndrome, acute renal failure, gangrenous digits, hypertension, pancreatitis, myocardial infarction, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, and rhabdomyolysis has been rarely reported in patients on thrombolytic drug
- When administering alteplase infusion, antiarrhythmic therapy for bradycardia and/or ventricular irritability should be readily available
- Discontinue alteplase infusion, if pretreatment International Normalized Ratio (INR) > 1.7 or a prothrombin time (PT) > 15 seconds or an elevated activated partial thromboplastin time (aPTT) is identified
- It is not recommended to treat patients with acute ischemic stroke more than 3 hours after onset of symptom
- Patients with minor neurological deficit or with rapidly improving symptoms should not be treated with alteplase therapy
- While treating patient with pulmonary embolism, consider the possible risk of reembolization due to the lysis of underlying deep venous thrombi
- Concomitantly provide Standard management of myocardial infarction or pulmonary embolism with alteplase therapy
- Avoid noncompressible arterial puncture, internal jugular and subclavian venous punctures to minimize bleeding from noncompressible sites
- Alteplase therapy causes orolingual angioedema in patients treated for acute ischemic stroke and in patients treated for acute myocardial infarction (post marketing experience), promptly discontinue the therapy and provide appropriate therapy
Cautions: Use cautiously in
- Severe hepatic dysfunction
- Recent major surgery
- Cerebrovascular disease
- Recent trauma
- Recent GI or GU bleeding
- Hypertension
- Risk of left heart thrombus
- Acute pericarditis
- Subacute bacterial endocarditis or acute pericarditis
- Hemostatic defects
- Pregnancy
- Hemorrhagic ophthalmic conditions
- Septic thrombophlebitis
- Elderly patients >75 yrs
- Oral anticoagulants use
- Severe neurological deficit
- Early infarct signs
Pregnancy Category:C
Breastfeeding: Safety Unknown. Manufacturer advises caution.
