Thrombolytics / Fibrinolytics
Alteplase (tPA)
Activase · Cathflo
Recombinant tissue plasminogen activator (fibrinolytic)
Converts fibrin-bound plasminogen to plasmin → dissolves formed clot. Fibrin-selective.
Indications
- •Acute ischemic stroke (<4.5 h)
- •Massive/submassive PE with instability
- •STEMI (when PCI unavailable)
- •Occluded central line (low-dose Cathflo)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Ischemic stroke | 0.9 mg/kg IV (max 90); 10% bolus, rest over 60 min | — |
| Massive PE | 100 mg IV over 2 h | — |
| Line clearance | 2 mg in catheter, dwell, aspirate | — |
Pharmacokinetics
Onset immediate. Half-life ~5 min — but fibrinolytic/bleeding effect persists longer.
Side effects
- !Intracranial + systemic hemorrhage
- !Angioedema (esp. with ACE inhibitors)
- !Reperfusion arrhythmias
Contraindications
- ×Active bleeding / recent hemorrhagic stroke
- ×Recent major surgery/trauma
- ×Uncontrolled HTN
- ×Recent neuraxial procedure
Clinical pearls
- ★Neuraxial is a hard stop around thrombolytics — avoid for ~10 days after a neuraxial procedure and monitor closely if given.
- ★Stroke dose (0.9 mg/kg) differs from PE dose (100 mg flat) — do not confuse.
- ★Angioedema risk rises with concurrent ACE inhibitors.
Other drugs in Thrombolytics / Fibrinolytics
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.
