Dangerous Drug: Alteplase, Recombinant (Recombinant Tissue-Type Plasminogen Activator, Rt-PA(al ti plaze’)
Activase, Cathflo Activase
PREGNANCY CATEGORY C
Drug Classes
Thrombolytic enzyme
Tissue plasminogen activator (TPA)
Therapeutic Actions
Human tissue enzyme produced by recombinant DNA techniques; converts plasminogen to the enzyme plasmin (fibrinolysin), which degrades fibrin clots; lyses thrombi and emboli; is most active at the site of the clot and causes little systemic fibrinolysis.
Indications
Treatment of coronary artery thrombosis associated with acute MI; improvement of ventricular function following MI; reduction of the incidence of heart failure and mortality associated with MI (Activase)
Treatment of acute, massive pulmonary embolism in adults (Activase)
Treatment of acute ischemic stroke (Activase)
Restoration of function to central venous access devices occluded as assessed by the ability to withdraw blood (Cathflo Activase)
Unlabeled uses: Treatment of unstable angina, frostbite, pleural effusion
Contraindications and Cautions
Contraindicated with allergy to TPA; active internal bleeding; recent (within 2 mo) stroke; intracranial or intraspinal surgery or neoplasm; recent major surgery, obstetric delivery, organ biopsy, or rupture of a noncompressible blood vessel; recent serious GI bleed; recent serious trauma, including CPR; SBE; hemostatic defects; cerebrovascular disease; early-onset, insulin-dependent diabetes; septic thrombosis; severe uncontrolled hypertension; subarachnoid hemorrhage; concurrent use of anticoagulants; low platelet count (<100,000); administration of heparin within 48 hr; concurrent use of warfarin.
Use cautiously with hepatic disease in elderly (older than 75 yr—risk of bleeding may be increased), pregnancy, lactation.
Available Forms
Powder for injection—50, 100 mg; single use powder for injection (Cathflo Activase)—2 mg
Dosages
Careful patient assessment and evaluation are needed to determine the appropriate dose of
this drug. Because experience is limited with this drug, careful monitoring is essential.
this drug. Because experience is limited with this drug, careful monitoring is essential.
Adults
Acute MI: For patients weighing more than 67 kg, 100 mg as a 15-mg IV bolus followed by 50 mg infused over 30 min. Then 35 mg over the next 60 min. For patients weighing 67 kg or less, 15-mg IV bolus followed by 0.75 mg/kg infused over 30 min (not to exceed 50 mg). Then, 0.5 mg/kg over the next 60 min (not to exceed 35 mg). For a 3-hr infusion, 60 mg in first hr (6–10 mg as a bolus); 20 mg over second hr; 20 mg over third hr. Patients weighing less than 65 kg should receive 1.25 mg/kg over 3 hr.
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