Alteplase

(Redirected from TPA)

Administration

  • Type: Thrombolytic
  • Dosage Forms: powder for injection (reconstitute before use)
  • Routes of Administration: IV
  • Common Trade Names: tPA

Adult Dosing

Acute MI

  • >67kg: 15mg IV over 1-2min; then 50mg IV over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
  • ≤67kg: 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) IV over 30 min; then 0.5 mg/kg over 60min (max 35 mg)

Acute ischemic stroke

  • 0.9mg/kg IV (max 90mg total)
    • 10% of dose is administered as bolus; rest is given over 60 minutes

Massive PE

  • Stable Massive PE: 100mg IV over 2 hr OR 0.6mg/kg over 2 min
  • Cardiac arrest: 50mg IV over 2 min followed by 50mg IV after 15 min if needed

Arterial thrombosis

  • 1.5 mg/hour by transcatheter intra-arterial infusion until lysis of thrombus

Pediatric Dosing

  • PE: 0.5 mg/kg/hour IV, for a maximum of 6 hours, in addition to heparin

Special Populations

Contraindications

  • Allergy to class/drug
  • Bleeding diathesis
  • Active internal bleeding
  • Current intracranial hemorrhage, subarachnoid hemorrhage
  • Intracranial neoplasm, arteriovenous malformation, aneurysm, or other conditions that may increase the risk of intracranial bleeding
  • Recent (<3 mo) intracranial or intraspinal surgery
  • Recent (<3 mo) serious head trauma
  • Recent (<3 mo) stroke (for patients being treated for MI or PE)
  • Severe uncontrolled hypertension

Adverse Reactions

Serious

  • Bleeding! Post-tPA Hemorrhage in CVA
  • GI bleed
  • Pericardial effusion, pericarditis, cardiac tamponade
  • Intracranial hemorrhage, cerebral herniation
  • Stroke, seizure
  • Anaphylaxis, angioedema
  • Pulmonary edema, pleural effusion
  • Cardiac dysrhythmia
  • Post-tPA Airway Edema
    • Stop tPA immediately
    • Famotidine 40 mg IV
    • Diphenhydramine 50 mg IV
    • Methylprednisolone 125 mg IV
    • Consider early airway management PRN

Common

Pharmacology

  • Onset of action: 30-60 minutes
  • Half-life: 26.5 to 46 minutes
  • Metabolism: Liver
  • Excretion:

Mechanism of Action

  • Tissue plasminogen activator (TPA): binds fibrin, enhances conversion of plasminogen to plasmin thus initiating fibrinolysis

Comments

See Also

References