Alteplase a is a drug that breaks down blood clots (thrombolytic). This drug breaks up blood clots that clog arteries and cause diseases, such as heart attacks and strokes. Alteplase can only be used based on a doctor's prescription.

Alteplase works by helping the formation process of plasmin, which is a blood protein that can break up and dissolve blood clots or emboli . This drug can be used to break up blood clots that have formed in heart attack, stroke, or pulmonary embolism patients.

Alteplase brand name: Actilyse

What is Alteplase

Group Prescription drugs
Category Fibrinolytic
Benefits Breaking blood clots in heart attack, stroke, or pulmonary embolism patients
Used by Adults
Alteplase for pregnant and lactating women Category C:  Studies on experimental animals show side effects on the fetus, but there are no controlled studies on pregnant women.

Medicines can only be used if the magnitude of the expected benefit exceeds the magnitude of the risk to the fetus.

It is not yet known whether alteplase can be absorbed into breast milk or not. If you are breastfeeding, do not use this medicine without telling your doctor.

Drug form Injection

Precautions Before Using Alteplase

Before using alteplase, you need to pay attention to the following things:

  • Do not use alteplase if you have an allergy to this medicine.
  • Alteplase should not be used in patients with bleeding disorders, active bleeding or bleeding that occurred in the last 3 months, including brain bleeding, gastrointestinal bleeding , and bleeding due to surgery or severe injury.
  • Tell your doctor if you are experiencing esophageal varices, active hepatitis, cirrhosis, aneurysm, uncontrolled hypertension, or if you have ever had a brain tumor . Alteplase should not be used in this condition.
  • Tell your doctor if you are or have suffered from hypertension , stroke, heart disease, endocarditis , liver disease, kidney disease, or vision impairment due to diabetes ( diabetic retinopathy ).
  • Tell the doctor if you have just undergone a biopsy of an internal organ.
  • Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant.
  • Inform the doctor if you are using medicines, including supplements, or herbal products, to anticipate the occurrence of drug interactions.
  • See a doctor immediately if you experience a drug allergic reaction or overdose after using this drug.

Dosage and Administration of Alteplase

Alteplase is given by injection into a vein or IV/intravenously. The following is the general dosage of alteplase based on the type of disease to be overcome:

Condition: Acute myocardial infarction

  • Adults with body weight ≥65 kg: 15 mg in 1 injection, followed by 50 mg by infusion over 30 minutes, then continued by 35 mg by infusion over 1 hour. The maximum dose is 100 mg.
  • Adults with body weight <65 kg: 15 mg in 1 injection, then followed by 0.75 mg/kgBW by infusion over 30 minutes, and followed by 0.5 mg/kgBW by infusion over 1 hour. The maximum dose is 100 mg.

Condition: Acute massive pulmonary embolism

  • Adults: 10 mg in 1 injection given over 1–2 minutes, then followed by 90 mg by infusion over 2 hours. The maximum dose is 100 mg.

Condition: Acute ischemic stroke

  • Adults: 0.9 mg/kgBW which is divided into 2 administrations, namely by injection in the first 1 minute, and by infusion for the remaining 60 minutes. The maximum dose is 90 mg.

How to Use Alteplase Correctly

Alteplase is only available as an injection. Therefore, this medicine can only be given by a doctor or by a medical worker under the supervision of a doctor. The dose of alteplase will be adjusted according to the patient's condition. In order for the treatment to obtain maximum results, the use of alteplase will be strictly supervised by a doctor.

Alteplase Interactions with Other Drugs

There are several interactions that can occur if alteplase is used with other drugs, including:

  • Decreased effectiveness of alteplase if used with tranexamic acid or glyceryl trinitrate
  • Increased risk of bleeding if used with anticoagulant or antiplatelet drugs .
  • Increased risk of reactions such as anaphylaxis if used with ACE inhibitors

Side Effects and Dangers of Alteplase

A side effect that often occurs due to the use of alteplase is bleeding. Therefore, see a doctor immediately if you experience bruising or light bleeding that does not stop. Immediately go to the IGD if you experience severe bleeding symptoms, such as:

  • BAB bloody or black
  • Urine is red or dark
  • Vomiting blood or clots like coffee grounds
  • Heavy menstrual bleeding or vaginal bleeding outside of menstruation
  • Symptoms of a hemorrhagic stroke (bleeding in the brain), such as a severe headache, weakness or numbness on one side of the body, difficulty speaking or understanding speech, and sudden visual disturbances

Some other side effects that can appear after using alteplase are:

  • Nausea
  • Vomiting
  • Turn
  • Fever

Check with a doctor if the complaints mentioned above do not subside or get worse. See a doctor immediately if you experience  a drug allergic reaction or experience more serious side effects, such as:

  • Bruising or bleeding that does not stop
  • Symptoms of kidney disorders, such as decreased urination, swelling in the legs, or drastic weight gain
  • Symptoms of acute pancreatitis , such as severe pain in the abdomen that spreads to the back, nausea, vomiting
  • Increased blood pressure, which can be marked by headaches, blurred vision, anxiety, or nosebleeds
  • Slow heartbeat , shortness of breath, and dizziness as if fainting
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