Thrombolytics
Indications
- Thrombolytics for acute ischemic stroke
- Thrombolytics for pulmonary embolism
- Thrombolytics for STEMI
Thrombolysis contraindications
Absolute contraindication
- Any prior ICH
- Known structural cerebral vascular lesion (AVM)
- Known intracranial neoplasm
- Ischemic stroke within 3 mo
- Active internal bleeding (excluding menses)
- Suspected aortic dissection or pericarditis
Relative contraindications
- Severe uncontrolled BP (>180/110)
- History of chronic severe poorly controlled hypertension
- History of ischemic stroke within past 3 months
- Known intracranial pathology not covered in absolute contraindications
- Current use of anticoagulants with known INR >2–3
- Known bleeding diathesis
- Recent trauma (past 2 wk)
- Prolonged CPR (>10 min)
- Major surgery (<3 wk)
- Noncompressible vascular punctures (e.g. subclavian) within past 7 days
- Recent internal bleeding (within 2–4 wk)
- Patients treated previously with streptokinase should not receive streptokinase again
- Pregnancy
- Active peptic ulcer disease
- Other medical conditions likely to increase risk of bleeding (diabetic retinopathy, etc)
Thrombolytics in STEMI
Alteplase (TPA)
Dosing based on patient weight:
- 67kg: Infuse 15mg IV over 1-2min; then 50mg over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
- ≤67kg: Infuse 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) over 30 min; then 0.5 mg/kg over 60min (max 35 mg)
Tenecteplase (TNKase)
- Reconstitute 50 mg vial in 10 mL sterile water (5 mg/mL)
- < 60 kg = 30 mg IV push over 5 seconds
- 60-69 kg = 35 mg IV push over 5 seconds
- 70-79 kg = 40 mg IV push over 5 seconds
- 80-89 kg = 45 mg IV push over 5 seconds
- > 90 kg = 50 mg IV push over 5 seconds