Generic Name:

Alteplase

Trade Name:

Activase

Action:

Tissue Plasminogen Activator (tPA)

Indications:

Peripheral venous thrombosis

Catheter occlusion

Administration Guidelines:

Usual Dosage Range and Route:

Catheter occlusion

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 (2 mL); retain in catheter for 0.5-2 hours; may instill a second dose if catheter remains occluded

Restoration of PICC lines may be implemented only by an IV Nurse

Catheter occlusion with fibrin sheath- 4 hour continuous infusion

Infusion: 0.5 mg/hr for 4 hours. See special considerations for post infusion.

Peripheral Venous Thrombosis-Systemic Thrombolysis Approach

Loading dose: None

Infusion: 0.5-4 mg/h for 24 h (recommended max 50mg/24 hours)

Heparin should be started after altepase infusion is completed (no loading dose) to maintain the aPTT in a therapeutic range .

Peripheral Venous Thrombosis-Catheter-directed Thrombolysis

Initial Or Loading Dose Must Be Administered By Physician

Loading dose: 4-10mg administered during procedure

Maintenance Infusion: 0.5-4mg/hr for 4-24 hours IV. Recommended cumulative maximum of 50 mg (Load plus infusion).

Heparin should be used at a low non-weight adjusted dose (eg 250 units/hr) keeping aPTT <1.5 times baseline during alteplase infusion.

Standard Concentration:

Catheter occlusion: 2mg/2mL (Cathflo) - Add 2.2 mL sterile water for injection to vial. DO NOT use bacteriostatic water.Mix gently until contents are dissolved. DO NOT shake. Final concentration: 1 mg/mL.

Peripheral venous thrombosis: 50mg/500mL, 25mg/250mL

Catheter occlusion with fibrin sheath -4mg/80mL NS

Suggested Maximum Dose:

Total 24 hour dose not to exceed 100 mg for infusions

Special Considerations:

Catheter occlusion:

- Instill and let dwell for 30 minutes. Do not force solution into catheter.

-leave syringe in place and do not close clamps on the catheter t allow the t-Pa to move freely into the catheter as the fibrin dissolves.

-Aspirate for blood return. If catheter is functional aspirate and discard 4-5 mL of blood for patients > 10 kg or 3 mL of blood from patients < 10 kg to remove the medication and residual clot.

-Gently irrigate the catheter with normal saline flush.

-If catheter is non functional after 30 minute dwell, continue to allow t-PA to dwell for up to 2 hours- then aspirate for blood return. If catheter still not functional withdraw instilled solution. May instill second dose.

-On rare occasions the t-Pa dose may not be aspirated, but flushing of catheter may be possible.

Infusions:

- Infusion should not be interrupted and should not be administered in the same IV line as other medications.

- Avoid intramuscular injections and vascular punctures at non-compressible sites before, during and after therapy.

- Check neuro vital signs every 2 hours.

- Contraindicated in patients with recent trauma, hemorrhagic stroke, surgery, active GI bleed within 2 months, coagulopathy or known bleeding diathesis.

- Should be used with caution in patients who have received chest compressions.

- Should be used with caution in patients who are currently on Heparin, Coumadin or antiplatelet drugs

-Peripheral venous thrombosis; Check fibrinogen levels every 6 hours and consider holding when less than 100 mg/dl

Precautions and Side Effects for infusions:

- Hemorrhage, bleeding from iv sites

- Fever

- Hypotension

- Reperfusion arrhythmias

- Anaphylaxis

-Hemorrhagic stroke