Actilyse50mg

Acute Ischemic Stroke:

• 0.9 mg/kg IV (max 90 mg total dose)
• 10% of total dose as IV bolus over 1 minute, remainder infused over 60 minutes
• Initiate within 3-4.5 hours of symptom onset
• Discontinue if INR >1.7 or aPTT is elevated

Acute Myocardial Infarction (Heart Attack):

• Weight-based dose (max 100 mg)
• Accelerated regimen (1.5 hr): 15 mg IV bolus (1-2 min), then 50 mg over 30 min, remaining 35 mg over 60 min
• 3-hour regimen: 6-10 mg IV bolus, then 50-54 mg in 1st hour, then 20 mg/hour for next 2 hours

Pulmonary Embolism:

• 100 mg IV infusion over 2 hours

Central Venous Catheter Occlusion:

• 2 mg (2 mL) instilled into occluded catheter
• Attempt to aspirate after 30 minutes; 2nd dose may be given after 120 minutes

Most common and serious side effect: Bleeding (hemorrhage) - internal bleeding, cerebral hemorrhage, injection site bleeding, nosebleeds, gum bleeding, black or tarry stools.

Other side effects: Decreased blood pressure, nausea, vomiting, fever, allergic reactions, orolingual angioedema (swelling of tongue and throat), cholesterol embolization, reembolization.

• Bleeding risk: Most serious side effect. Avoid intramuscular injections. Monitor for bleeding. Discontinue alteplase if serious bleeding occurs.
• Angioedema: Monitor during and for several hours after infusion. Discontinue if angioedema develops.
• Cholesterol embolization: Rarely reported with thrombolytic agents.
• Reembolization: Consider risk of reembolization from lysis of underlying DVT in PE patients.
• Pregnancy: Animal studies have shown harmful effects on the fetus; use only if clearly needed.