Alteplase indication

Alteplase Administration Protocol for Cerebrovascular Accident Indication... 

Streptokinase is not indicated for use in acute ischemic stroke treatment. Three large randomized controlled trials evaluating streptokinase were stopped early due to a high incidence of hemorrhage in the streptokinase-treated patients.14-16 At the present time, there is no indication for the use of streptokinase or thrombolytics other than alteplase in the acute treatment of ischemic stroke. 

Practice guidelines indicate that a more fibrin-specific agent (alteplase, reteplase, tenecteplase) is preferred over the non-fibrin-specific agent streptokinase. Fibrin-specific agents open a greater percentage of infarct arteries, which results in smaller infarcts and lower mortality. 

Plasminogen, an inactive precursor, is activated to plasmin which as a protease is able to break down fibrin clots. The thrombolytic agents in use promote the conversion of plasminogen to plasmin at the site of a thrombus. Indications include post-myocardial infarction treatment. The thrombolytic must be administered within 6 hours for an optimal effect. Other indications are treatment of acute pulmonary thromboembolism, deep-vein thrombosis, acute arterial thrombosis and thromboembolism, as well as in the clearance of arteriovenous catheters and can-nulae. Agents are streptokinase, anistreplase, urokinase, alteplase, reteplase and tenecteplase. 

Alteplase was the first commercially available recombinant tissue-type plasminogen activator (rt-PA) (25), It has a plasma half-life of less than five minutes and is metabolized by the liver, This agent was initially hailed as fibrin-specific unlike its precursors (urokinase and streptokinase). It was thought that this would result in a better safety profile, but this has not been born out in either the coronary or the peripheral experience, where actually there may be a higher bleeding risk as infusion time increases. Alteplase is currently indicated for use in the treatment of myocardial infarction, acute ischemic stroke, and pulmonary embolism. 

Alteplase (6 to 10 mg IV bolus over the first 1 to 2 minutes, then 20 mg/hour for an additional 2 hours) is indicated for lysis of thrombi obstructing coronary arteries in management of acute myocardial infarction (see Eigure 44). 

Alteplase aids in dissolution of blood clots. It is indicated in the lysis of thrombi in management of acute myocardial infarction (MI) or acute massive pulmonary embolism, and... 

The nurse is administering alteplase (Activase), a thrombolytic, to a client diagnosed with massive pulmonary emboli (PE). Which data indicates the medication is effective ... 

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