Reteplase administration

Pharmacologic management of thrombosis includes local administration of thrombolytic agents. Alteplase (2 mg per port) and reteplase (0.5 unit per port) are the two most commonly used agents today. Urokinase has been used in the past, but after its reintroduction to the United States market, the larger dosed vial size makes it less cost effective than the newer agents. 

The laek of glyeosylation as well as the absenee of the EGF and Ki domains (Table 9.11) eonfers an extended serum half-life upon the engineered moleeule. Reteplase-based produets display a serum half-life of up to 20 min, faeilitating its administration as a single bolus injection... 

F. Role in therapy Reteplase is a novel thrombolytic agent. It has a longer half-life than alteplase, which allows bolus administration. Its administration technique is much simpler than that of alteplase. In addition reteplase has achieved more rapid, complete, and sustained thrombolysis of the infarct-related artery compared to standard doses of alteplase with comparable safety. Reteplase is at least as effective as streptokinase and alteplase in AMI. 

E Role in therapy Thrombolytic agents currently licensed for the treatment of AMI in the United States include streptokinase, tissue plasminogen activator, anistreplase, reteplase, and tenecteplase. TNKase and alteplase have similar clinical efficacy for thrombolysis after myocardial infarction (i.e., similar mortality and intracranial hemorrhage rates). However, advantages of TNKase include ease and rapidity of administration, longer half-life, greater fibrin specificity, and lower noncerebral bleeding rates. Reteplase shares some characteristics of tenecteplase (e.g., similar half-life, rapid onset, and ease of administration). 

Pro-urokinase, alteplase, reteplase, and tenecteplase, which are recombinant products, also appear to be free from allergic reactions. Pro-urokinase and alteplase have short half-lives (3-8 minutes) and require continuous infusion administration, which may in some cases be an advantage as it allows rapid surgical intervention when necessary (53). Reteplase and tenecteplase have substantially longer half-lives, allowing bolus administration. 

Randomised, double-blind comparison of reteplase doublebolus administration with streptokinase in acute myocardial infarction (INJECT) trial to investigate equivalence. International Joint Efficacy Comparison of Throm, bolytics. Lancet 1995 346(8971) 329-36. 

Smalling RW, Bode C, Kalbfleisch J, et al. More rapid, complete, and stable coronary thrombolysis with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction. RAPID Investigators. Circulation 1995 91 2725-2732. 

Kastrati A, Mehilli J, Schlotterbeck K, Dotzer F, Dirschinger J, Schmitt C, Nekolla SG, Seyfarth M, Martinoff S, Markwardt C, Clermont G, Gerbig HW, Leiss J, Schwaiger M, Schomig A Bavarian Reperfusion Alternatives Evaluation (BRAVE) Study Investigators. Early administration of reteplase plus abdximab vs. abciximab alone in patients with acute myocardial infarction referred for percutaneous coronary intervention a randomized controlled trial. JAMA 2004 291(8) 947-954. 

Kastrati A, MehUli J, Schlotterbeck K, et al. Early administration of reteplase plus abdximab vs. abciximab alone in patients with acute myocardial infarction referred for percutaneous coronary intervention a randomized controlled trial. JAMA. 2004 291 947-954. 

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