Pharm

t-PA

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t-PA, tPA, Alteplase, Activase

  • See Also
  1. Thrombolytic
  2. Thrombolysis in Massive Pulmonary Embolism
  3. Thrombolysis in Cerebrovascular Accident
  4. Thrombolysis in ST Elevation Myocardial Infarction
  5. t-PA (Alteplase)
  6. ST Elevation MI (STEMI)
  • Dose
  1. Myocardial Infarction
    1. Bolus: 15 mg IV THEN
    2. Next: 0.75 mg/kg (max 50 mg) over 30 minutes THEN
    3. Next: 0.5 mg/kg (max 35 mg) over next 60 minutes
    4. Administer adjunctive Heparin concurrently
      1. See Thrombolysis
  2. Acute Ischemic Cerebrovascular Accident
    1. Calculate total dose: 0.9 mg/kg (max 90 mg)
    2. Bolus: Give 10% total dose as IV bolus over 1 minute
    3. Next: Give remainder of total dose over 60 minutes
  3. Acute Massive Pulmonary Embolus
    1. Pulse present
      1. First: 10 mg IV bolus
      2. Next: 90 mg IV over 2 hours
    2. Pulse absent
      1. tPA 50 mg IV bolus and continue CPR for at least 30 minutes (to allow for tPA circulation)
    3. Restart Heparin when PTT below twice normal
  • Disadvantages (compared with other Thrombolytics)
  1. Cost: $1200
  2. Increased bleeding risk
    1. 3-4% greater risk of bleeding in older than age 75
  3. Re-occludes earlier than other Thrombolytics
    1. Needs Heparin concurrently and afterward
  • Advantages (compared with other Thrombolytics)
  1. Probably reperfuses arteries earlier
  2. Superior in large, anterior Myocardial Infarctions