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1 High Alert bleeding diathesis; Severe uncontrolled hypertension (systolic BP ⬎185 mmHg or di-
astolic BP ⬎110 mmHg specifically for stroke indication); Evidence or suspicion of
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alteplase (al-te-plase) intracranial hemorrhage on pretreatment evaluation (for stroke indication only); Re-
Activase, Cathflo Activase, tissue plasminogen activator, t-PA cent (within 3 mo) stroke (for stroke indication only); History of intracranial hemor-
rhage (for stroke indication only); Seizure at the onset of stroke (for stroke indica-
Classification tion only); Current use of oral anticoagulants or an INR ⬎1.7 or a prothrombin time
Therapeutic: thrombolytics ⬎15 sec (for stroke indication only); Administration of heparin 48 hr before the on-
Pharmacologic: plasminogen activators set of stroke with an elevated aPTT at presentation (for stroke indication only); Plate-
Pregnancy Category C let count ⬍100,000/mm3 (for stroke indication only); Hypersensitivity (for central
venous access device occlusion indication only).
Indications Use Cautiously in: Recent (within 10 days) major surgery, trauma, GI or GU
Acute myocardial infarction (MI). Acute ischemic stroke. Pulmonary embolism bleeding; Cerebrovascular disease; Systolic BP ⱖ175 mmHg and/or diastolic BP
(PE). Occluded central venous access devices. Unlabeled Use: Deep venous ⱖ110 mmHg; High likelihood of left heart thrombus; Hemostatic defects; Severe he-
thrombosis (DVT). Acute peripheral arterial thrombosis. patic impairment; Hemorrhagic ophthalmic conditions; Septic thrombophlebitis;
Previous puncture of a noncompressible vessel; Subacute bacterial endocarditis or
Action acute pericarditis; Severe neurological deficit (NIHSS ⬎22) at presentation (for
Directly converts plasminogen to plasmin, which then degrades clot-bound fibrin. stroke indication only); Major early infarct signs on CT scan (for stroke indication
Therapeutic Effects: Lysis of thrombi in coronary arteries, with improvement of only); Known or suspected infection in catheter (for central venous access device oc-
ventricular function, and reduced risk of heart failure or death. Lysis of pulmonary clusion indication only); Geri: ⬎75 yr;qrisk of intracranial bleeding; OB, Lacta-
emboli. Lysis of thrombi causing ischemic stroke, reducing risk of neurologic se- tion, Pedi: Safety not established.
quelae. Restoration of cannula or catheter function. Exercise Extreme Caution in: Patients receiving concurrent anticoagulant
Pharmacokinetics therapy (qrisk of intracranial bleeding).
Absorption: Complete after IV administration. Intracoronary administration or Adverse Reactions/Side Effects
administration into occluded catheters or cannulae has a more localized effect. CNS: INTRACRANIAL HEMORRHAGE. EENT: epistaxis, gingival bleeding. Resp: bron-
Distribution: Unknown. chospasm, hemoptysis. CV: reperfusion arrhythmias, hypotension, RECURRENT IS-
Metabolism and Excretion: Rapidly metabolized by the liver. CHEMIA/THROMBOEMBOLISM. GI: GI BLEEDING, nausea, RETROPERITONEAL BLEEDING,
Half-life: 35 min. vomiting. GU: GU TRACT BLEEDING. Derm: ecchymoses, flushing, urticaria. Hemat:
TIME/ACTION PROFILE (fibrinolysis) BLEEDING. Local: hemorrhage at injection site, phlebitis at injection site. MS: mus-
ROUTE ONSET PEAK DURATION
culoskeletal pain. Misc: allergic reactions including ANAPHYLAXIS, fever.
IV 30 mi 60 min unknown Interactions
Drug-Drug: Aspirin, other NSAIDs, warfarin, heparin and heparin-like
Contraindications/Precautions agents, abciximab, eptifibatide, tirofiban, clopidogrel, ticlopidine, or dipy-
Contraindicated in: Active internal bleeding; History of cerebrovascular accident ridamole— concurrent useqrisk of bleeding, although these agents are frequently
(for MI and PE only); Recent (within 3 mo) intracranial or intraspinal injury or used together or in sequence. Effects may bepby antifibrinolytic agents, including
trauma; Intracranial neoplasm, arteriovenous malformation, or aneurysm; Known aminocaproic acid or tranexamic acid.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/alteplase 02/11/2014 08:48AM Plate # 0-Composite pg 2 # 2
4
Patient/Family Teaching PDF Page #4
● Explain purpose of medication and the need for close monitoring to patient and
family. Instruct patient to report hypersensitivity reactions (rash, dyspnea) and
bleeding or bruising.
● Explain need for bedrest and minimal handling during therapy to avoid injury.
Avoid all unnecessary procedures such as shaving and vigorous tooth brushing.
Evaluation/Desired Outcomes
● Lysis of thrombi and restoration of blood flow.
● Prevention of neurologic sequelae in acute ischemic stroke.
● Cannula or catheter patency.
Why was this drug prescribed for your patient?