Alteplase

Also known as: Tissue-type plasminogen activator precursor tPA t-PA t-plasminogen activator

Therapeutic indications

Alteplase is indicated for:

Acute massive pulmonary embolism with haemodynamic instability

Population group: both men and women, only adults (18 years old or older)

Alteplase is indicated for the thrombolytic treatment in acute massive pulmonary embolism with haemodynamic instability. The diagnosis should be confirmed whenever possible by objective means such as pulmonary angiography or non-invasive procedures such as lung scanning. There is no evidence for positive effects on mortality and late morbidity related to pulmonary embolism.

For this indication, competent medicine agencies globally authorize below treatments (click for details):

Treatment 1: Intravenous - 100 mg in 2 hours

Acute myocardial infarction

Population group: both men and women, only adults (18 years old or older)

Alteplase is indicated for thrombolytic treatment in acute myocardial infarction.

90 minutes (accelerated) dose regimen: for patients in whom treatment can be started within 6 h after symptom onset.

3 h dose regimen: for patients in whom treatment can be started between 6-12 h after symptom onset provided that the diagnosis has been clearly confirmed.

For this indication, competent medicine agencies globally authorize below treatments (click for details):

Treatment 1: Intravenous - 90 minutes administration

Treatment 2: Intravenous - 3 h dose regimen

Acute ischaemic stroke

Population group: both men and women, only adults (18 - 65 years old)

Alteplase is indicated for the fibrinolytic treatment of acute ischaemic stroke. Treatment must be started as early as possible within 4.5 hours after onset of stroke symptoms and after exclusion of intracranial haemorrhage by appropriate imaging techniques (e.g. cranial computerised tomography or other diagnostic imaging method sensitive for the presence of haemorrhage). The treatment effect is time-dependent; therefore earlier treatment increases the probability of a favourable outcome.

For this indication, competent medicine agencies globally authorize below treatments (click for details):

Treatment 1: Intravenous - 0.9 mg/kg body weight

Contraindications

Alteplase is contraindicated in the following cases:

Haemorrhage

Bleeding

Severe uncontrolled arterial hypertension

Bacterial endocarditis, pericarditis

at least one of
Bacterial endocarditis

Pericarditis

Αcute pancreatitis

Acute pancreatitis

Neoplasm with increased bleeding risk

Neoplasms

Ulcerative gastrointestinal disease, oesophageal varices, arterial-aneurysm, arterial/venous malformations

at least one of
Gastrointestinal ulcer

Esophageal varices

Arterial aneurysm

Severe liver disease, hepatic failure, cirrhosis, portal hypertension, active hepatitis

at least one of
Hepatic failure stage IV

Inflammatory disorder of liver

Portal hypertension