reteplase

MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name: Reteplase

Trade Name: Retavase®

Action: Thrombolysis

Indications: Acute Myocardial Infarction, Peripheral Arterial and Venous Thrombolysis

Administration Guidelines:

Usual Dosage Range and Route:

Acute Myocardial Infarction:

Doses may be administered by RN with MD at bedside

10 units intravenous push (IVP) over 2 minutes. Repeat an additional 10 units IVP (over 2 minutes) 30 minutes after the initiation of the first dose (total = 20 units). Do not co-administer any other medications through reteplase line while administering reteplase. Flush line with D5W or 0.9% NaCl after each bolus.

Arterial Thrombolysis:

loading dose of 5 units

0.25 units/hour (low dose regimen) total dose

1 unit/hr (high dose regimen) total dose

Heparin subtherapeutic dose of 100-150 units/hour. The dose of heparin is not altered on the basis of a PTT.

Infusions are continued for a maximum of 48 hours.

Venous Thrombolysis:

loading dose of 2 units

0.5-1 unit/hour (Total dose)

Heparin at full therapeutic dose to maintain the PTT at more than 2 times control.

Infusions are continued for up to 72 hours.

Standard Concentration:

Acute Myocardial Infarction:

10 Units / 10ml (10 Units = 17.4 mg)

Peripheral Thrombolysis:

5 units / 250ml NS (coaxial)
10 units/500ml NS

Mixing Guidelines:

Using aseptic technique, reconstitute the first 10 units vial with 10ml preservative free sterile water for injection (PF SWI). Using the needle, syringe, and PF SWI included in kit. Allow contents to dissolve by gently swirling vial (do NOT shake). Mix second bolus using the same procedure immediately prior to administration.

Suggested Maximum Dose: Total dose not to exceed 20 units

Fibrinogen monitoring: A baseline pre-infusion (arterial/venous overnight infusions) fibrinogen level should be obtained for patients receiving Retavase. Subsequent fibrinogen levels should be obtained at 6 hour intervals. If the fibrinogen level drops below 100, the Retavase infusion can be either reduced or terminated. Fibrinogen levels should stabilize with a reduction in Retavase dose.

Special considerations:

For MI dosing, bolus should not be interrupted and should not be administered in the same line as other medications.
Avoid intramuscular injections and vascular punctures at non-compressible sites before, during and after therapy.
Check neuro vital signs every hour.
Should be used with caution in patients who have received chest compressions.
Should be used with caution in patients who are also receiving heparin, warfarin, or anti-platelet drugs.

Precautions and Side Effects:

Hemorrhage, bleeding from IV sites
Fever
Hypotension
Reperfusion arrhythmias
Anaphylaxis (rare)
Hemorrhagic stroke, cerebrovascular accidents, further thromboembolic events
Use with caution in patients with a hypersensitivity or allergy to other plasminogen activators

Contraindications:

Absolute:

Recent CVA

Active intrathoracic/abdominal bleeding

Intracranial neoplasm, AVM or aneurysm

Relative:

Recent major surgery/organ biopsy (within 10 days)

Recent GI bleed

Recent obstetrical delivery

Severe arterial hypertension (systolic > 180mmHg, diastolic > 110mmHg)

Septic thrombophlebitis

Known bleeding diathesis

Pregnancy

Age > 75

Endocarditis

revised 09/03