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'''Alteplase''' ('''t-PA''') is a [[thrombolytic medication]], used to treat acute [[ST elevation myocardial infarction]] (a type of heart attacks), [[pulmonary embolism]] associated with [[low blood pressure]], acute [[ischemic stroke]], and blocked [[central venous access device]]s (CVAD).<ref name=AHFS2019/> It is given by [[injection into a vein]] or [[artery]].<ref name=AHFS2019/>
'''Alteplase''' ('''t-PA''') is a [[thrombolytic medication]], used to treat acute [[ST elevation myocardial infarction]] (a type of heart attacks), [[pulmonary embolism]] associated with [[low blood pressure]], acute [[ischemic stroke]], and blocked [[central venous access device]]s (CVAD).<ref name=AHFS2019/> It is given by [[injection into a vein]] or [[artery]].<ref name=AHFS2019/>


== Contraindications ==<!-- Side effects and mechanism -->
== Indications and Contraindications ==
The use of alteplase is similar to those of other [[Thrombolysis|thrombolytics]], but can vary depending on the pathology.<ref>{{Cite journal|last=WRITING COMMITTEE MEMBERS*|last2=O’Gara|first2=Patrick T.|last3=Kushner|first3=Frederick G.|last4=Ascheim|first4=Deborah D.|last5=Casey|first5=Donald E.|last6=Chung|first6=Mina K.|last7=de Lemos|first7=James A.|last8=Ettinger|first8=Steven M.|last9=Fang|first9=James C.|last10=Fesmire|first10=Francis M.|last11=Franklin|first11=Barry A.|date=2013-01-29|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines|url=https://www.ahajournals.org/doi/10.1161/CIR.0b013e3182742cf6|journal=Circulation|language=en|volume=127|issue=4|doi=10.1161/CIR.0b013e3182742cf6|issn=0009-7322}}</ref><ref>{{Cite journal|last=Powers|first=William J.|last2=Rabinstein|first2=Alejandro A.|last3=Ackerson|first3=Teri|last4=Adeoye|first4=Opeolu M.|last5=Bambakidis|first5=Nicholas C.|last6=Becker|first6=Kyra|last7=Biller|first7=José|last8=Brown|first8=Michael|last9=Demaerschalk|first9=Bart M.|last10=Hoh|first10=Brian|last11=Jauch|first11=Edward C.|date=2019-12|title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association|url=https://www.ahajournals.org/doi/10.1161/STR.0000000000000211|journal=Stroke|language=en|volume=50|issue=12|doi=10.1161/STR.0000000000000211|issn=0039-2499}}</ref>

=== Acute Ischemic Stroke ===

=== Myocardial Infarction ===

=== Pulmonary Embolism ===<!-- Side effects and mechanism -->
Common side effects are bleeding including [[intracranial hemorrhage|intracranial bleeding]] and [[GI bleeding]].<ref name=AHFS2019/> Other side effects may rarely include [[allergic reactions]].<ref name=AHFS2019/> It is not recommended in those allergic to [[gentamicin]].<ref name=BNF76>{{cite book|title=British national formulary : BNF 76|date=2018|publisher=Pharmaceutical Press|isbn=9780857113382|pages=216|edition=76}}</ref> Safety of use in [[pregnancy]] is unclear.<ref name=Preg2019>{{cite web |title=Alteplase Use During Pregnancy |url=https://www.drugs.com/pregnancy/alteplase.html |website=Drugs.com |accessdate=12 November 2019 }}</ref> Alteplase is a manufactured form of [[tissue plasminogen activator]].<ref name=AHFS2019/> It works by converting [[plasminogen]] to [[plasmin]] in a blood clot.<ref name=AHFS2019/>
Common side effects are bleeding including [[intracranial hemorrhage|intracranial bleeding]] and [[GI bleeding]].<ref name=AHFS2019/> Other side effects may rarely include [[allergic reactions]].<ref name=AHFS2019/> It is not recommended in those allergic to [[gentamicin]].<ref name=BNF76>{{cite book|title=British national formulary : BNF 76|date=2018|publisher=Pharmaceutical Press|isbn=9780857113382|pages=216|edition=76}}</ref> Safety of use in [[pregnancy]] is unclear.<ref name=Preg2019>{{cite web |title=Alteplase Use During Pregnancy |url=https://www.drugs.com/pregnancy/alteplase.html |website=Drugs.com |accessdate=12 November 2019 }}</ref> Alteplase is a manufactured form of [[tissue plasminogen activator]].<ref name=AHFS2019/> It works by converting [[plasminogen]] to [[plasmin]] in a blood clot.<ref name=AHFS2019/>


Revision as of 18:59, 21 October 2020

Alteplase
Clinical data
Trade namesActivase, Actilyse, others
Other namest-PA, rt-PA
AHFS/Drugs.comMonograph
License data
ATC code
Legal status
Legal status
Identifiers
CAS Number
DrugBank
ChemSpider
  • none
UNII
KEGG
Chemical and physical data
FormulaC2569H3928N746O781S40
Molar mass59042.52 g·mol−1
  (verify)

Alteplase (t-PA) is a thrombolytic medication, used to treat acute ST elevation myocardial infarction (a type of heart attacks), pulmonary embolism associated with low blood pressure, acute ischemic stroke, and blocked central venous access devices (CVAD).[2] It is given by injection into a vein or artery.[2]

Indications and Contraindications

The use of alteplase is similar to those of other thrombolytics, but can vary depending on the pathology.[3][4]

Acute Ischemic Stroke

Myocardial Infarction

Pulmonary Embolism

Common side effects are bleeding including intracranial bleeding and GI bleeding.[2] Other side effects may rarely include allergic reactions.[2] It is not recommended in those allergic to gentamicin.[5] Safety of use in pregnancy is unclear.[1] Alteplase is a manufactured form of tissue plasminogen activator.[2] It works by converting plasminogen to plasmin in a blood clot.[2]

Alteplase was approved for medical use in the United States in 1987.[2][6] It is on the World Health Organization's List of Essential Medicines.[7]

Medical uses

The main uses of alteplase are acute ischemic stroke, acute myocardial infarction, and acute massive pulmonary embolism.[8]

In regards to acute myocardial infarction, a randomized controlled trial of people with acute STEMI, showed there was no reduction in microvascular obstruction when adjunctive low-dose intracoronary alteplase was administered during the primary PCI.[9]

Mechanism of action

Alteplase is a serine protease that assists fibrin in the conversion of plasminogen to plasmin. When in the systemic circulation, alteplase binds to fibrin in a thrombus and initiates fibrinolysis.[8]

Society and culture

It is on the World Health Organization's List of Essential Medicines,[7] having been added in 2019.[10]

References

  1. ^ a b "Alteplase Use During Pregnancy". Drugs.com. Retrieved 12 November 2019.
  2. ^ a b c d e f g "Alteplase Monograph for Professionals". Drugs.com. Retrieved 11 November 2019.
  3. ^ WRITING COMMITTEE MEMBERS*; O’Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; de Lemos, James A.; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A. (29 January 2013). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (4). doi:10.1161/CIR.0b013e3182742cf6. ISSN 0009-7322.
  4. ^ Powers, William J.; Rabinstein, Alejandro A.; Ackerson, Teri; Adeoye, Opeolu M.; Bambakidis, Nicholas C.; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M.; Hoh, Brian; Jauch, Edward C. (2019-12). "Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 50 (12). doi:10.1161/STR.0000000000000211. ISSN 0039-2499. {{cite journal}}: Check date values in: |date= (help)
  5. ^ British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 216. ISBN 9780857113382.
  6. ^ "Activase: FDA-Approved Drugs". U.S. Food and Drug Administration (FDA). Retrieved 4 January 2020.
  7. ^ a b World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  8. ^ a b "Activase- alteplase kit". DailyMed. 5 December 2018. Retrieved 4 January 2020.
  9. ^ McCartney, Peter (January 2019). "Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients with Acute Myocardial Infarction". JAMA. 321 (1): 56–68. doi:10.1001/jama.2018.19802. PMC 6583564. PMID 30620371.
  10. ^ World Health Organization (2019). Executive summary: the selection and use of essential medicines 2019: report of the 22nd WHO Expert Committee on the selection and use of essential medicines. Geneva: World Health Organization. hdl:10665/325773. WHO/MVP/EMP/IAU/2019.05. License: CC BY-NC-SA 3.0 IGO.

External links

  • "Alteplase". Drug Information Portal. U.S. National Library of Medicine.
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