Generic Name

Alteplase

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Classification

FDA Approved Indications

• Acute ischemic stroke
• Myocardial infarction (heart attack)
• Massive pulmonary embolism
• Occluded central venous access devices (Cathflo Activase)

Mechanism of Action

Alteplase binds to fibrin in a thrombus (clot) and converts plasminogen to plasmin, leading to fibrin degradation and clot dissolution.

Dosage and Administration

Adult: Dose varies by indication; for ischemic stroke, typically 0.9 mg/kg (maximum 90 mg) over 60 minutes, with 10% given as initial bolus.

Pediatric: Approved for certain pediatric clotting conditions; dosing varies by condition.

Geriatric: Use caution; adjust dose based on clinical judgment and patient condition.

Renal Impairment: Adjustment not typically required but monitor closely.

Hepatic Impairment: Data limited; use caution and monitor closely.

Pharmacokinetics

Absorption: Administered intravenously; immediate systemic availability.

Distribution: Widely distributed in tissues.

Metabolism: Rapidly metabolized by the liver and plasma enzymes.

Excretion: Excreted mainly in the urine.

Half Life: Approximately 5 minutes.

Contraindications

• Active bleeding
• History of recent intracranial hemorrhage
• Recent head trauma or CNS surgery
• Known bleeding disorders

Precautions

• Use with caution in patients on anticoagulants, with recent surgery, or with uncontrolled hypertension. Monitor closely for bleeding complications.

Adverse Reactions - Common

• Bleeding at vascular access site or other sites (Very common)
• Hypersensitivity reactions (Uncommon)

Adverse Reactions - Serious

• Intracranial hemorrhage (Rare)
• Systemic bleeding leading to significant blood loss (Uncommon)

Drug-Drug Interactions

• Other anticoagulants, antiplatelet agents, and fibrinolytics increase bleeding risk.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of bleeding immediately (nosebleeds, blood in stool, rapid heartbeat).
• Avoid unnecessary invasive procedures during therapy.
• Inform about increased bleeding risk during and after therapy.

Special Considerations

Black Box Warnings:

• Serious risk of intracranial and systemic bleeding. Use only in approved indications with proper monitoring.

Genetic Factors: None specified.

Lab Test Interference: May cause false-positive results in coagulation assays.

Overdose Management

Signs/Symptoms: Severe bleeding, hypotension.

Treatment: Discontinue alteplase, provide supportive care, administer blood products as needed, and manage bleeding according to protocols.

Storage and Handling

Storage: Store at 2-8°C, do not freeze.

Stability: Stable until the expiration date on the vial when refrigerated.