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Thrombolytics
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(Redirected from Thrombolytic)
Contents
Thrombolytics in STEMI
Alteplase (TPA)
Dosing:
- >67kg pt:
- Infuse 15mg IV over 1-2min; then 50mg over 30min; then 35mg over next 60min (i.e. 100mg over 1.5hr)
- ≤67kg pt:
- Infuse 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) over 30 min; then 0.5 mg/kg over 60min (max 35 mg)
Tenecteplase-TNKase
- Reconstitute 50 mg vial in 10 mL sterile water (5 mg/mL)
- < 60 kg = 30 mg IV push over 5 seconds
- 60-69 kg = 35 mg IV push over 5 seconds
- 70-79 kg = 40 mg IV push over 5 seconds
- 80-89 kg = 45 mg IV push over 5 seconds
- > 90 kg = 50 mg IV push over 5 seconds
Indications and Contraindications[1]
- Indications[2]
- Chest pain > 30 min but less than 12 hrs, not relieved by NTG
- PCI greater than 90 min away
- ECG criteria of STEMI
- STE in 2 contiguous leads
- Posterior STEMI
- LBBB with Sgarbossa criteria
- Absolute contraindications
- Prior ICH
- Known cerebral vascular lesion, AVM
- Known intracranial malignancy, primary or mets
- Ischemic stroke within 3 months, but not ischemic stroke within 3 hrs
- Suspected aortic dissection
- Active bleeding or bleeding diathesis, excluding menses
- Significant closed head/facial trauma within 3 months
- Relative contraindications
- History of chronic, severe hypertension
- SBP > 180 or DBP > 110 mmHg
- History of prior ischemic stroke > 3 months, dementia, or other known intracranial pathology not in absolute contraindications
- Traumatic CPR or CPR > 10 min
- Major surgery within 3 wks
- Internal bleeding within 2-4 wks
- Noncompressible vascular punctures
- Prior allergic reactions to fibrinolytics
- Pregnancy
- Active PUD
- Use of anticoagulants
Thrombolysis in Acute Ischemic Stroke (tPA)
Alteplase
Dosing:
- 0.9mg/kg IV (max 90mg total)
- 10% of dose is administered as bolus; rest is given over 60min
- Neuro check Q15min x 2hr
- No anticoagulation/antiplatelets x 24hr
- Blood pressure (keep SBP <180, DBP <105)
If SBP is >180-230 or DBP is >120:
- Nicardipine 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR
- Labetalol 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
- Labetalol 10mg IV followed by infusion at 2–8 mg/min
If BP not controlled by above measures:
- Nitroprusside 0.5–10mcg/kg/min
- Continuous arterial monitoring advised
- Use with caution in patients with hepatic or renal insufficiency
Thrombolysis in Pulmonary Embolism
- See pulmonary embolism management section
See Also
References
- ↑ Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview#a3.
- ↑ ACLS Training Center. Fibrinolytic Checklist for STEMI. ../docss/algo-fibrinolytic.pdf