Thrombolytic Dosing
#1
Alteplase (Activase, tPA)
Acute MI: (>67kg): 15 mg IV bolus over 1-2 minutes, then 50 mg over 30 minutes, then 35 mg over next 60 minutes. (<67kg): 15 mg IV bolus, followed by 0.75 mg/kg (maximum 50mg) over 30 minutes, then 0.5 mg/kg (maximum 35mg) over the next 60 minutes. Note: Concurrently, begin heparin 60 units/kg bolus (maximum: 4000 units) followed by continuous infusion of 12 units/kg/hour (maximum: 1000 units/hour) and adjust to aPTT target of 1.5-2 times the upper limit of control. Infuse remaining 35 mg of alteplase over the next hour.

Acute PE: 100mg IV over 2 hours, then restart heparin when PTT < twice normal.

Acute ischemic stroke: Doses should be given within the first 3 hours of the onset of symptoms. Recommended total dose: 0.9 mg/kg (maximum dose should not exceed 90 mg) infused over 60 minutes. Load with 0.09 mg/kg (10% of the 0.9 mg/kg dose) as an IV bolus over 1 minute, followed by 0.81 mg/kg (90% of the 0.9 mg/kg dose) as a continuous infusion over 60 minutes. Heparin should not be started for 24 hours or more after starting alteplase for stroke.

Central venous catheter clearance: Intracatheter (Cathflo™ Activase® 1 mg/ml): Patients <30 kg: 110% of the internal lumen volume of the catheter, not to exceed 2 mg/2 ml. Retain in catheter for 0.5-2 hours. May instill a second dose if catheter remains occluded. Patients >30 kg: 2 mg/2ml- retain in catheter for 0.5-2 hours - may instill a second dose if catheter remains occluded.

Acute peripheral arterial occlusive disease (unlabeled use): Intra-arterial: 0.02-0.1 mg/kg/hour for up to 36 hours. The most common indications for thrombolysis were peripheral arterial occlusion and venous thrombosis. Preparation: Continuous infusion of alteplase (50 mg of alteplase reconstituted in 50 mL of sterile water and diluted with 0.9% normal saline solution to a concentration of 0.1 to 0.2 mg/mL). Infusion rate: 0.5 to 2 mg/hr x 6 to 72 hours depending on location.

Supplied: 50 mg, 100 mg vial ( powder for reconstitution). Cathflo: 2 mg.


Tenecteplase (TNKase)
Acute MI: Treatment should be initiated as soon as possible after the onset of AMI symptoms. The recommended total dose should not exceed 50 mg and is based upon patient weight. A single bolus dose should be administered over 5 seconds based on patient weight.

Patient Wt (kg)  TNKase (mg)   Volume (ml) over 5 seconds
< 60                            30mg                   6ml 
60 to < 70                    35                       7 
70 to < 80                    40                       8 
80 to < 90                    45                       9 
Over 90                       50                      10  


Preparation: dilute 50mg vial with 10ml sterile water (packaged with diluent and syringe).

All patients received 150-325 mg of aspirin as soon as possible and then daily. Intravenous heparin was initiated as soon as possible and aPTT was maintained between 50-70 seconds.  Tenecteplase is incompatible with dextrose solutions.

Supplied: 50 mg vial ( powder for reconstitution).
"They that are whole have no need of the physician, but they that are sick" -  Jesus of Nazareth
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