How is Activase (alteplase) given/administered?

How Activase is given or administered depends upon the patient’s weight and what it is being used to treat (such as a stroke, pulmonary embolism, or myocardial infarction). For example, when used to treat a heart attack (myocardial infarction), there are two Activase dose regimens, an accelerated and a 3-hour regimen, with different recommendations depending on if the patient is over 67kg or not.

FDA-approved indications for Activase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters.

Recommended administration of Activase for pulmonary embolism (PE)

• Administer 100mg by IV infusion over 2 hours.
• Start parenteral anticoagulation immediately following or towards the end of the infusion once the partial thromboplastin time or thrombin time returns to twice normal or less.

Recommended administration of Activase for myocardial infarction with ST-segment elevation (STEMI) (heart attack)

• Administer Activase as soon as possible after the onset of symptoms, and within 30 minutes of hospital arrival.
• Activase may be administered by either the accelerated or 3-hour regimen. The dosage is based on a patients weight but should not exceed 100 mg, regardless of the selected administration regimen.

Accelerated regimen

• Adults weighing 67 kg or less get a 15 mg IV bolus, followed by 0.75 mg/kg IV (not to exceed 50 mg) infused over 30 minutes, and then 0.5 mg/kg IV (not to exceed 35 mg) over the next 60 minutes
• Adults greater than or equal to 67 kg get a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes

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3-hour regimen

• Adults weighing less than 65 kg, administer a bolus of 0.075 mg/kg, followed by 0.675 mg/kg over the rest of the first hour, then 0.25 mg/kg over the 2nd hour, then 0.25 mg/kg over the 3rd hour.
• Adults weighing 65kg or more, administer 6-10mg as a bolus, followed by 50-54mg over the rest of the first hour, then 20mg over the 2nd hour, then 20mg over the 3rd hour.

Recommended administration of Activase for Acute Ischemic Stroke

• Administer Activase as soon as possible but within 3 hours after symptom onset.
• Calculate the dose based on the patient’s weight at 0.9 mg/kg (not to exceed 90 mg total dose. Administer 10% of the total dose as an IV bolus over 1 minute then infuse the remainder over 60 minutes.
• Frequently monitor and control blood pressure.
• Can initiate Activase prior to the availability of coagulation study results in patients without recent use of oral anticoagulants or heparin. Discontinue Activase if the pretreatment International Normalized Ratio (INR) is greater than 1.7 or the activated partial thromboplastin time (aPTT) is elevated.

Recommended administration of Activase for IV Catheter Occlusion

• Instill 2 mg of Activase in the occluded lumen and allow it to sit for 2-hours.
• Repeat this dose if the first attempt is not successful. The use of more than 4mg of Activase for this indication has not been studied.