Tissue Plasminogen Activator (tPA®, Activase®, Recombinant Alteplase®)
Fibrinoloytic, Thrombolytic agent1)
Tissue plasminogen activator is a naturally-occurring enzyme derived from DNA technology. The enzyme binds to fibrin-bound plasminogen at the site of an arterial clot, thus converting plasminogen to plasmin. Plasmin digests the fibrin strands of the clot and restores perfusion to the occluded artery.
Clot lysis often occurs within 60-90 minutes
½ hour (80% cleared in 10 minutes)
Acute evolving myocardial infarction
Evolving ischemic CVA (only approved fibinolytic for this purpose)
Massive pulmonary emboli
Arterial thrombosis and embolism
To clear arteriorvenous cannulas.
Active bleeding
Recent surgery (within 2-3 weeks)
Recent hemmorhagic CVA
Prolonged CPR
Intracranial or intraspinal surgery
Recent significant trauma (particularly head trauma)
Uncontrolled hypertension
Bleeding (GI, GU, intracranial, other sites)
Allergic reactions
Hypotension
Chest pain
Reperfusion dysrhythmias
Abdominal pain
Active bleeding
Acetylsalicylic acid may increase risk of bleeding ( may also be beneficial in improving overall effectiveness).
Heparin and other anticoagulants may also increase risk of bleeding and improve overall effectiveness
20 mg (with 20 ml of diluent)
50 mg (with 50 ml of diluent)
May further dilute with equal amounts of 0.9% sodium chloride of D5W.
IV: 15 mg bolus over 2 min, then 50 mg over the next 30 minutes, then 35 mg over the next 60 minutes.
Not recommended
Pregnancy Safety: Contraindicated
Gently roll – do not shake- the vial to mix powder with liquid.
Closely monitor vital signs
Observe for bleeding
Obtain blood sample for coagulation studies prior to administration.
Do not administer IM injections to patients receiving thrombolytic drugs.
No arterial blood gas specimens should be drawn on potential thrombolytic therapy candidates due to bleeding tendency.
Use caution when moving patient to prevent bruising or bleeding