Alteplase
Synonyms :
Activase, rt-PA, TPA
Mechanism :
Alteplase is a recombinant human tissue-type plasminogen activator (t-PA); it produces local fibrinolysis by converting plasminogen to plasmin; plasmin in turn degrades fibrin and fibrinogen.
Indication :
- Central venous catheter occlusion.
Contraindications :
Hypersensitivity, Active internal haemorrhage or history of intracranial hemorrhage, bleeding diathesis, Ischemic Stroke (within 3 months), Recent GI or GU bleeding, Hypertension: Systolic BP >175 mm Hg and/or diastolic BP >110 mm Hg, Acute pericarditis, Subacute bacterial endocarditis, High likelihood of left heart thrombus (e.g., mitral stenosis with atrial fibrillation).
Dosing :
<30 kg: Instill a volume equal to 110% of the internal lumen volume of the catheter. Maximum dose: 2 mg in 2 ml. The dose can be repeated in 2 hours if catheter remains occluded.
>30 kg: 2 mg instilled into the occluded catheter (reconstituted to a 1 mg/1 ml concentration).
Maximum dose: 2 mg/dose. The dose can be repeated in 2 hours if catheter remains occluded.
Use with caution in severe renal and hepatic impairment.
Adverse Effect :
Sepsis, shock, re-occlusion, idioventricular rhythm, pulmonary edema, arterial embolism, hypotension, DVT, pulmonary embolism, nausea, vomiting, hemorrhage, hypersensitivity reactions.
Interaction :
Prothrombin: The use of alteplase with prothrombin complex concentrates (human) is contraindicated because of pharmacodynamic synergism.
Apixaban and Alteplase: Both significantly increase anti coagulation and therefore should not be used together.
Ceftaroline: Increases the effects of alteplase (mild effect).
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended. Use with caution