rt-PA
Fibrinolytic (recombinant tissue plasminogen activator)
Preparation: 1 mg/ml after reconstitution (e.g. 50 mg in 50 ml)
Acute ischaemic stroke (≤ 4.5 h)
- 0.9 mg/kg i.v. – 10 % of this as a bolus over 1 min, remainder over 60 min[239]max. 90 mg · 1 mg/ml after reconstitution (e.g. 50 mg in 50 ml)
After exclusion of haemorrhage (CT/MRI), within 4.5 h of symptom onset. Do not delay thrombectomy in large-vessel occlusion.
Alteplase – Acute ischaemic stroke (≤ 4.5 h)
| BW | 0.9 mg/kg i.v. – 10 % of this as a bolus over 1 min, remainder over 60 min · 1 mg/ml after reconstitution |
|---|---|
| 50 kg | 45 mg 45 ml |
| 60 kg | 54 mg 54 ml |
| 70 kg | 63 mg 63 ml |
| 80 kg | 72 mg 72 ml |
| 90 kg | 81 mg 81 ml |
| 100 kg | 90 mg 90 ml |
| 120 kg | 90 mg 90 ml max |
High-risk pulmonary embolism (shock)
- 100 mg i.v. – 10 mg bolus over 1–2 min, then 90 mg over 2 h[239]1 mg/ml after reconstitution (e.g. 50 mg in 50 ml) · = 100 ml
- 0.6 mg/kg i.v. – accelerated regimen over 15 min (off-label, not licensed)[222]max. 50 mg · 1 mg/ml after reconstitution (e.g. 50 mg in 50 ml)
Body weight < 65 kg – total dose max. 1.5 mg/kg (SmPC). The accelerated regimen is listed in the 2019 ESC guideline but is explicitly not licensed (off-label, e.g. in extreme instability). Concomitant heparin therapy according to SmPC/ESC.
Alteplase – High-risk pulmonary embolism (shock)
| BW | 0.6 mg/kg i.v. – accelerated regimen over 15 min (off-label, not licensed) · 1 mg/ml after reconstitution |
|---|---|
| 50 kg | 30 mg 30 ml |
| 60 kg | 36 mg 36 ml |
| 70 kg | 42 mg 42 ml |
| 80 kg | 48 mg 48 ml |
| 90 kg | 50 mg 50 ml max |
| 100 kg | 50 mg 50 ml max |
| 120 kg | 50 mg 50 ml max |
Cardiac arrest with (suspected) pulmonary embolism
- Consider fibrinolysis; ERC does not specify a dosing regimen. Commonly used is the accelerated ESC regimen 0.6 mg/kg (max. 50 mg), which ESC describes for administration over 15 min – an immediate bolus is to be distinguished from this; follow local protocol i.v. – off-label[1]
After thrombolysis, continue CPR for 60–90 min.
Contraindications
- Previous intracranial haemorrhage or stroke of unknown origin
- CNS damage, CNS tumour or AV malformation
- Recent major trauma, surgery or head injury
- Active bleeding, known bleeding tendency
- Aortic dissection
- In stroke, additionally observe the indication-specific criteria of the SmPC
Notes
- In high-risk PE and during resuscitation, contraindications are relative – weigh benefit/risk.
- Angio-oedema possible (especially with ACE inhibitors) during thrombolysis for stroke.