Alteplase Tabs

Date/Time:

Package Insert

Med Administration Guide

Calculate Dose for PE

100 mg IV infusion over 2 hours without a bolus.

Alternatively, 50 mg bolus over 2-15 minutes then repeat in 30 minutes.

  1. Stop Heparin Infusion during Alteplase infusion.
  2. STAT aPTT, CBC, Fibrinogen after Alteplase infusion.
  3. Obtain aPTT q4h until aPTT less than or equal to 80 seconds and resume full UFH.
  4. If Fibrinogen less than 100 mg/dL, reduce infusion rate to 10 units/kg/hr.
  5. Repeat Fibrinogen with each aPTT until over 100 mg/dL.

Calculate Dose for IC administration in the Cath Lab

Actual Wt (kg) Dose (mg)
40-45 20
46-50 21
51-55 23
56-60 25
61-66 27
67+ 30

Guidelines

  1. IC tPA may be administered in conjunction with DAPT, UFH and GP-1.
  2. Recommend ACT of 250-300 seconds during the procedure.
  3. IC tPA dose is 30% of the corresponding full IV dose in STEMI:
    • tPA dose is 30 mg if actual weight is greater or equal to 67 kg.
    • tPA dose is [(15mg+1.25mg/kg) x 0.3] if actual weight is less than 67 kg.
  4. Administer IC tPA over 5 min. through non-side hole guiding catheter or IC infusion catheter device.
  5. Consider repeat manual aspiration 10-15 min. after IC tPA administration.
  6. Avoid a second dose of IC tPA (not studied).
  7. Obtain Fibrinogen and CBC at end of procedure in Cath Lab.

NOTE:

  1. Pharmacy to supply 50 mg vial of tPA to Cath lab STAT after phone call (without EPIC order).
  2. Cath Lab to reconstitute 50 mg vial of tPA with 25 ml non-bacteriostatic sterile water (2 mg/ml).
  3. Gently swirl slowly to dissolve powder, draw up appropriate dose, and administer within 1 hour per guidelines.

Calculate Dose for AIS (Max dose at 100kg)

   

Total Dose: 

   Waste:  ()

   Bolus:   mg over 1-2 min.

   Infusion:   mg over 60 min.

NOTE:Hold antiplatelet/anticoagulants for at least 24 hours.


Wt(kg) Total Dose Bolus Infusion Waste
1 0.9 0.1 0.8 99.1
2 1.8 0.2 1.6 98.2
3 2.7 0.3 2.4 97.3
4 3.6 0.4 3.2 96.4
5 4.5 0.5 4.1 95.5
6 5.4 0.5 4.9 94.6
7 6.3 0.6 5.7 93.7
8 7.2 0.7 6.5 92.8
9 8.1 0.8 7.3 91.9
10 9 0.9 8.1 91
11 9.9 1 8.9 90.1
12 10.8 1.1 9.7 89.2
13 11.7 1.2 10.5 88.3
14 12.6 1.3 11.3 87.4
15 13.5 1.4 12.2 86.5
16 14.4 1.4 13 85.6
17 15.3 1.5 13.8 84.7
18 16.2 1.6 14.6 83.8
19 17.1 1.7 15.4 82.9
20 18 1.8 16.2 82
21 18.9 1.9 17 81.1
22 19.8 2 17.8 80.2
23 20.7 2.1 18.6 79.3
24 21.6 2.2 19.4 78.4
25 22.5 2.3 20.3 77.5
26 23.4 2.3 21.1 76.6
27 24.3 2.4 21.9 75.7
28 25.2 2.5 22.7 74.8
29 26.1 2.6 23.5 73.9
30 27 2.7 24.3 73
31 27.9 2.8 25.1 72.1
32 28.8 2.9 25.9 71.2
33 29.7 3 26.7 70.3
Wt(kg) Total Dose Bolus Infusion Waste
34 30.6 3.1 27.5 69.4
35 31.5 3.2 28.4 68.5
36 32.4 3.2 29.2 67.6
37 33.3 3.3 30 66.7
38 34.2 3.4 30.8 65.8
39 35.1 3.5 31.6 64.9
40 36 3.6 32.4 64
41 36.9 3.7 33.2 63.1
42 37.8 3.8 34 62.2
43 38.7 3.9 34.8 61.3
44 39.6 4 35.6 60.4
45 40.5 4.1 36.5 59.5
46 41.4 4.1 37.3 58.6
47 42.3 4.2 38.1 57.7
48 43.2 4.3 38.9 56.8
49 44.1 4.4 39.7 55.9
50 45 4.5 40.5 55
51 45.9 4.6 41.3 54.1
52 46.8 4.7 42.1 53.2
53 47.7 4.8 42.9 52.3
54 48.6 4.9 43.7 51.4
55 49.5 5 44.6 50.5
56 50.4 5 45.4 49.6
57 51.3 5.1 46.2 48.7
58 52.2 5.2 47 47.8
59 53.1 5.3 47.8 46.9
60 54 5.4 48.6 46
61 54.9 5.5 49.4 45.1
62 55.8 5.6 50.2 44.2
63 56.7 5.7 51 43.3
64 57.6 5.8 51.8 42.4
65 58.5 5.9 52.7 41.5
66 59.4 5.9 53.5 40.6
Wt(kg) Tot. Dose Bolus Infusion Waste
67 60.3 6 54.3 39.7
68 61.2 6.1 55.1 38.8
69 62.1 6.2 55.9 37.9
70 63 6.3 56.7 37
71 63.9 6.4 57.5 36.1
72 64.8 6.5 58.3 35.2
73 65.7 6.6 59.1 34.3
74 66.6 6.7 59.9 33.4
75 67.5 6.8 60.8 32.5
76 68.4 6.8 61.6 31.6
77 69.3 6.9 62.4 30.7
78 70.2 7 63.2 29.8
79 71.1 7.1 64 28.9
80 72 7.2 64.8 28
81 72.9 7.3 65.6 27.1
82 73.8 7.4 66.4 26.2
83 74.7 7.5 67.2 25.3
84 75.6 7.6 68 24.4
85 76.5 7.7 68.9 23.5
86 77.4 7.7 69.7 22.6
87 78.3 7.8 70.5 21.7
88 79.2 7.9 71.3 20.8
89 80.1 8 72.1 19.9
90 81 8.1 72.9 19
91 81.9 8.2 73.7 18.1
92 82.8 8.3 74.5 17.2
93 83.7 8.4 75.3 16.3
94 84.6 8.5 76.1 15.4
95 85.5 8.6 77 14.5
96 86.4 8.6 77.8 13.6
97 87.3 8.7 78.6 12.7
98 88.2 8.8 79.4 11.8
99 89.1 8.9 80.2 10.9
100 90 9 81 10

Calculate Dose for AMI (Max dose at 68kg)

   

Waste:  () mg

   Bolus:  mg over 1 min.

   Step 1:   mg over 30 min.

   Step 2:   mg over 60 min. in evac. bag


  1. UFH 50 units/kg IVP (Max 4000 units).
  2. Alteplase 15 mg IVP over 1 min. regardless of weight.
  3. Alteplase infusion as calculated above.
  4. UFH infusion 12 units/kg/hr (Max 1000 units/hr) simultaneously with Alteplase infusion in a separate line.
    • aPTT goal: 50-70 seconds .
  5. CBC, Fibrinogen, aPTT 6 hours after UFH loading dose.

Additional pearls

  1. If patient started on GP blocker such as Eptifibatide (Integrelin) + Heparin → NO tPA
  2. If patient on chronic ADP blocker [Clopidogrel (Plavix), Prasugrel (Effient), Ticagrelor (Brillinta), Cangrelor (Elinogrel)] → tPA OK
  3. Clopidogrel (Plavix) is only ADP blocker to be given as adjunctive therapy with tPA
    • If less than or equal to 75 yo, Plavix 300mg PO x 1 then 75 mg po daily.
    • If over 75 yo, Plavix 75 mg po daily.

Wt(kg) Bolus Dose Step 1 Step 2 Waste
1 15 0.8 0.5 83.8
2 15 1.5 1 82.5
3 15 2.3 1.5 81.3
4 15 3 2 80
5 15 3.8 2.5 78.8
6 15 4.5 3 77.5
7 15 5.3 3.5 76.3
8 15 6 4 75
9 15 6.8 4.5 73.8
10 15 7.5 5 72.5
11 15 8.3 5.5 71.3
12 15 9 6 70
13 15 9.8 6.5 68.8
14 15 10.5 7 67.5
15 15 11.3 7.5 66.3
16 15 12 8 65
17 15 12.8 8.5 63.8
18 15 13.5 9 62.5
19 15 14.3 9.5 61.3
20 15 15 10 60
21 15 15.8 10.5 58.8
22 15 16.5 11 57.5
23 15 17.3 11.5 56.3
24 15 18 12 55
25 15 18.8 12.5 53.8
26 15 19.5 13 52.5
27 15 20.3 13.5 51.3
28 15 21 14 50
29 15 21.8 14.5 48.8
30 15 22.5 15 47.5
31 15 23.3 15.5 46.3
32 15 24 16 45
33 15 24.8 16.5 43.8
Wt(kg) Bolus Dose Step 1 Step 2 Waste
34 15 25.5 17 42.5
35 15 26.3 17.5 41.3
36 15 27 18 40
37 15 27.8 18.5 38.8
38 15 28.5 19 37.5
39 15 29.3 19.5 36.3
40 15 30 20 35
41 15 30.8 20.5 33.8
42 15 31.5 21 32.5
43 15 32.3 21.5 31.3
44 15 33 22 30
45 15 33.8 22.5 28.8
46 15 34.5 23 27.5
47 15 35.3 23.5 26.3
48 15 36 24 25
49 15 36.8 24.5 23.8
50 15 37.5 25 22.5
51 15 38.3 25.5 21.3
52 15 39 26 20
53 15 39.8 26.5 18.8
54 15 40.5 27 17.5
55 15 41.3 27.5 16.3
56 15 42 28 15
57 15 42.8 28.5 13.8
58 15 43.5 29 12.5
59 15 44.3 29.5 11.3
60 15 45 30 10
61 15 45.8 30.5 8.8
62 15 46.5 31 7.5
63 15 47.3 31.5 6.3
64 15 48 32 5
65 15 48.8 32.5 3.8
66 15 49.5 33 2.5
Wt(kg) Bolus Dose Step 1 Step 2 Waste
67 15 50 33.5 1.5
68+ 15 50 35 0

Prepare Dose