Thrombolytic

Class of Drug

Recombinant tissue plasminogen activator

[[Mode of Action]]

Activated when binds to [[fibrin]]. Converts plasminogen to plasmin which degrades fibrin matrix and lyses blood clot

Route and Dose

• Suspected or confirmed PE with Clinical cardiogenic Shock: 10 mg IV followed by IV infusion of 90mg over two hours
• Cardiac Arrest/periarrest: 50mg IV stat and 50mg IV over one hour post ROSC. Consider continuing CPR post thrombolysis for 60-90 minutes
• Normotensive but with evidence of right heart strain on echo or positive troponin: 50mg IV over one hour

Dilution and Rate of Administration

• Reconstitute 100mg of alteplase with 100ml sodium chloride 0.9% or glucose 5%. Concentration 1mg/ml

Indications

• Lysis of thrombi in acute massive PE
• Also used in treatment of ischaemic CVA and acute MI

Metabolism

• Hepatic

Excretion

• Renal

Side Effects

• Bleeding
• Nausea and Vomiting

Contraindications

• Recent/active Haemorrhage, anticoagulation or bleeding disorder, arterial aneurysm/dissection,
• Peptic ulcers, CNS tumour, previous haemorrhagic CVA, ischaemic CVA in last 3 months, major surgery in last 3 months, recent trauma, severe Hypertension, severe liver disease, active peptic ulcer, prolonged CPR, caution <10 days post partum, pregnancy

Important Drug Interactions

• Concurrent use of anticoagulants and antiplatelet drugs increases bleeding risk