Thrombolytic drugs are commonly used in emergency situations to break up or dissolve blood clots that have caused ischemia of the vital organs. Alteplase, also known as tissue plasminogen activator (tPA), is a thrombolytic agent produced by recombinant DNA technology. There are two brand formulations approved by the U.S. Food and Drug Administration. The first, Activase, is indicated to treat acute ischemic stroke (AIS), acute myocardial infarction (AMI), and acute massive pulmonary embolism (PE). The second, Cathflo Activase, is indicated to clear occluded central venous catheters and restore function to central venous access devices (Facts and Comparisons, 2022).
How does it work?
When a thrombus forms in an artery, it obstructs blood supply, causing ischemia and tissue necrosis. Alteplase, given intravenously (IV), binds to the fibrin-plasminogen complex in a thrombus and converts the inactive plasminogen into active plasmin which digests the fibrin. Alteplase can dissolve a thrombus in either the coronary or pulmonary artery, restoring the blood supply to the area beyond the blockage. The initial half-life of alteplase is less than 5 minutes and it is cleared primarily through the liver (Genentech, 2018).
Contraindications (Genentech, 2018)
Alteplase is contraindicated in patients with active internal bleeding, recent (within 3 months) severe head trauma or intracranial/intraspinal surgery, intracranial conditions that may increase the risk of bleeding (i.e., intracranial neoplasm, arteriovenous malformation, or aneurysm), bleeding diasthesis, and current severe uncontrolled hypertension. In patients with acute ischemic stroke, additional contraindications include current intracranial hemorrhage and subarachnoid hemorrhage. For patients with acute myocardial infarction or pulmonary embolism, do not administer alteplase if the patient has a history of recent stroke.
Monitoring (Genentech, 2018)
Patients receiving alteplase should be closely monitored for bleeding and hypersensitivity reactions. Regularly assess the patient’s neurologic status and blood pressure per your facilities’ policies and follow laboratory tests such as hemoglobin, hematocrit, platelets, fibrinogen, and activated partial thromboplastin time.
For complete information and dosing, please consult each drug’s specific package insert or the Nursing2022 Drug Handbook® + Drug Updates
. For a handy reference check out our NursingCenter pocket card: Alteplase Injection for Acute Ischemic Events