Other Brands/Names

Actylise.

How It Works

Alteplase is a thrombolytic medicine, meaning it helps restore blood flow to the affected tissue. It is an enzyme that breaks down and dissolves blood clots that can obstruct blood vessels.

Indications

Alteplase is used to treat acute myocardial infarction (heart attack), acute ischemic stroke (a stroke caused by arterial blockage in the brain), and acute pulmonary embolism (blood clots blocking blood flow in the lungs).

Contraindication

There are several situations in which this medicine must not be used:

• Bleeding disorders within the past 6 months

• Severe stroke

• Intracranial hemorrhage

• History of central nervous system injury (for example, brain tumor or spinal cord trauma)

• Markedly elevated blood pressure or severe, uncontrolled hypertension

• Infection involving the heart lining, such as endocarditis or pericarditis

• Pancreatitis

• Major surgery or significant trauma within the previous 3 months

• Serious liver disease, including liver failure or active hepatitis

Side Effects

Common adverse effects are bleeding-related, such as:

• Gum bleeding

• Black, tarry stools due to gastrointestinal bleeding (melena)

• Hematuria

• Hemoptysis

• Nosebleeds

Some effects are uncommon but more serious and may include:

• Ocular bleeding, rash, hives, airway narrowing, swelling beneath the skin, and fever. 

• Potentially fatal events can include severe spontaneous hemorrhage (intracranial, gastrointestinal, respiratory, or urinary tract), heart failure, pulmonary edema, and cardiac arrest.

Types

Alteplage is available as injection medications.

Dosage

• Acute myocardial infarction (heart attack)

Adults - accelerated regimen (give no later than 6 hours from symptom onset):

Body weight > 65 kg: 15 mg as an IV bolus, then 50 mg by infusion over 30 minutes, followed by 35 mg by infusion over 1 hour.

Body weight < 65 kg: 15 mg as an IV bolus, then 0.75 mg/kg (maximum 50 mg) infused over 30 minutes, followed by 0.5 mg/kg (maximum 35 mg) over 1 hour.

Maximum total dose: 100 mg.

3-hour regimen (administered 6–12 hours after symptom onset):

10 mg as an IV bolus, then 50 mg by infusion over 1 hour, followed by 10 mg infused over 30 minutes until the full 3-hour dose is delivered.

Maximum total dose: 100 mg (use 1.5 mg/kg in patients weighing < 65 kg).

• Acute pulmonary embolism

Adults: 10 mg as an IV bolus over 1–2 minutes, then 90 mg by infusion over 2 hours.

Maximum total dose: 100 mg (1.5 mg/kg if weight < 65 kg).

• Acute ischemic stroke

Adults: 0.9 mg/kg infused over 60 minutes, given within 3–4.5 hours of symptom onset; administer 10% of the dose as an initial bolus over the first minute.

Maximum total dose: 90 mg.

Safety

• Your clinician will check vital signs and cardiac monitoring before, during, and after therapy.
• Your neurological status will be assessed every 15 minutes during the infusion and every 30 minutes for the next 6 hours, then hourly for the subsequent 24 hours.
• Blood pressure and heart rate will be continuously monitored for at least 24 hours.
• Your risk of bleeding will be evaluated using clinical findings and laboratory tests.
• During pregnancy, use only if clearly necessary after discussing risks and benefits with your doctor.
• It is unknown whether this medicine is excreted in breast milk; consult your physician before breastfeeding.

Drug Interactions

• Increased bleeding risk when combined with coumarin derivatives, oral anticoagulants, antiplatelet agents, or heparin.

• Higher likelihood of severe, potentially life-threatening allergic reactions when used with ACE inhibitors (a class of antihypertensive medicines).

• Concomitant IV glyceryl trinitrate may interfere with clot breakdown.

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