Alteplase
A recombinant tissue plasminogen activator given by vein to dissolve clots in acute ischemic stroke, heart attack and massive pulmonary embolism.
Also called rt-PA (abbreviation (recombinant tissue plasminogen activator)) or tPA (abbreviation).
Drug card
- Class
- Thrombolytic
- How it works
- Turning plasminogen into plasmin, which breaks down the fibrin in clots
- Used for
- Acute ischemic stroke, within 3 hours of onset
- Acute heart attack, to lower death and heart failure
- Massive pulmonary embolism
- Known for
- Bleeding, including intracranial hemorrhage
- Its name
- -plase means a plasminogen activator (clot buster)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does alteplase work?
A recombinant copy of human tissue plasminogen activator, a serine protease. It attaches to the fibrin of a thrombus and turns the plasminogen held there into plasmin, so clot breakdown stays mostly local; without fibrin it activates plasminogen only weakly. Its initial half-life is under 5 minutes, so it is given as an infusion, after a bolus in stroke and heart attack.
Like other thrombolytics: They turn plasminogen into plasmin, the enzyme that cuts fibrin apart, so a clot that has already formed dissolves and the blocked vessel can reopen. Alteplase and tenecteplase are recombinant forms of tissue plasminogen activator: they bind fibrin in the thrombus and act mainly on the plasminogen trapped there, so circulating fibrinogen is broken down less.
Uses
What is alteplase used for?
- Acute ischemic stroke, within 3 hours of onset
- Acute heart attack, to lower death and heart failure
- Massive pulmonary embolism
Side effects
Side effects of alteplase
- Bleeding, including intracranial hemorrhageKnown forSerious
- Orolingual angioedemaSerious
- Anaphylaxis, laryngeal edema, hivesSerious
- Cholesterol embolismSerious
- Re-embolism from deep vein clotsSerious
- Arrhythmias and AV block after heart attackSerious
- Low blood pressure
- Nausea and vomiting
- Seizures (after stroke treatment)Serious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Stroke: exclude intracranial hemorrhage before treatment, and start within 3 hours of symptom onset.
- Contraindicated with internal bleeding, recent brain or spinal surgery or serious head injury, a bleeding diathesis, or severe uncontrolled hypertension.
- Avoid intramuscular injections and punctures of vessels that cannot be compressed; anticoagulants and antiplatelets add to bleeding.
- Patients on ACE inhibitors are more prone to orolingual angioedema; watch for it during and for hours after the infusion.
Good to know: Cleared within minutes, so it runs as an infusion; tenecteplase, a modified tPA, is given as a single bolus.
Remember it
A way to remember it
Lytics lyse: they make plasmin, and plasmin snips the fibrin that holds a clot together.
Their main danger follows from that action: bleeding, especially at puncture sites and inside the skull. Tranexamic acid works the opposite way, by keeping plasmin off fibrin.
Written for biofideX
Its name
-plase means plasminogen activator (clot buster)
Alteplase and tenecteplase are tissue plasminogen activators that dissolve clots. WHO lists them under -ase (enzymes) as -teplase; urokinase-type ones end in -uplase.
- Every drug name stem
Its class
Thrombolytics
Other thrombolytics with a card:
Easily mixed up with antifibrinolytics and heparins.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Alteplase for injection: label (DailyMed)
- Alteplase (NCI Thesaurus)
- Tenecteplase for injection: label (DailyMed)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood clots and cholesterol
Alteplase is one of 19 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
Start Practicing