tPA (2023) PDF - Portage College Paramedic Program

Box 417 Lac La Biche, AB T0A 2C0 Paramedic Program Generic Name: tissue plasminogen activator (tPA), alteplase Trade Name: Activase Classification: thrombolytic enzyme Supplied: 50 and 100 mg vials Actions (Pharmacodynamics):  Binds to fibrin in a thrombus and converts entrapped plasminogen to pl...

Box 417 Lac La Biche, AB T0A 2C0 Paramedic Program Generic Name: tissue plasminogen activator (tPA), alteplase Trade Name: Activase Classification: thrombolytic enzyme Supplied: 50 and 100 mg vials Actions (Pharmacodynamics):  Binds to fibrin in a thrombus and converts entrapped plasminogen to plasmin, initiating fibrinolysis  Degrades fibrin clots, fibrinogen and other plasma proteins  Acts on the dissolution stage. Protease which activates plasmin release from endothelial cells, due to ischemic conditions, thrombin, systemic adrenaline and histamine. It acts on plasminogen converting it to plasmin, which cleaves fibrin. Indications:  Lysis of thrombi obstructing coronary arteries in management of acute MI.  Lysis of thrombi obstructing cerebral arteries in the management of acute ischemic stroke. Dosage: STEMI 6- 12 hours of symptoms: >67 kg: 15 mg initial IV bolus; followed by 50 mg infused over the next 30 mins; then 35 mg infused over the next 60 mins < 67 kg: 15 mg initial IV bolus; followed by 0.75 mg/kg (not to exceed 50 mg) over the next 30 min; then 0.5 mg/kg (not to exceed 35 mg) over 60 min Acute Ischemic Stroke within 4.5 hours or wake-up and unknown time of onset: Ages 18 - 80 0.9 mg/kg (maximum 90 mg) IV, infused over 60 minutes; give 10% of total dose as an initial IV bolus over 1 min; give remaining 90% of total dose IV over next 60 minutes. Contraindications:  Ensure BGL is above 3.3 mmol/l (Stroke)  Any prior intracranial hemorrhage  Known structural cerebral vascular lesion (e.g., arteriovenous malformation)  Known malignant intracranial neoplasm (primary or metastatic)  Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 4.5 hours  Suspected aortic dissection  Active bleeding or bleeding diathesis (excluding menses)  Significant closed head trauma or facial trauma within 3 months  Intracranial or intraspinal surgery within 2 months  Severe uncontrolled hypertension (unresponsive to emergency therapy) Relative Contraindications:  History of chronic, severe, poorly controlled hypertension or Severe uncontrolled hypertension on presentation (SBP > 180 mm Hg or DBP >110 mm Hg) STEMI  History of chronic, severe, poorly controlled hypertension or Severe uncontrolled hypertension on presentation (SBP > 185 mm Hg or DBP >110 mm Hg) (Stroke)  History of prior ischemic stroke > 3 months, dementia, or known intracranial pathology not covered in contraindications  CPR (greater than 10 mins)  major surgery, trauma, GI or GU bleeding (within 10 days)  Recent (within 2 to 4 weeks) internal bleeding ©Portage College Paramedic Program Page 1 of 3        Notes:      Non-compressible vascular punctures Transient ischemic attack (TIA) within 6 months Pregnancy Active peptic ulcer Current use of anticoagulants (ex: Warfarin, Apixaban, Rivaroxaban, Dabigatran) (: the higher the INR, the higher the risk of bleeding Advanced liver disease Prior allergic reaction to these agents Due to the urgency of administering thrombolytic therapy within a limited time period, rapid EMS response, assessment, recognition and transport are critical elements in the prehospital management of the MI and stroke patient. Onset of time of stroke is either witnessed or last known normal Must be reconstituted with sterile water to 1 mg/ml Use 2 peripheral IV lines, one exclusively for fibrinolytic administration. Continuous monitoring of V/S q 15 for 2 hours post administration References: 1 (613) 5 (457-458) 8 (150), 9 (339, 342, 1533) 10 (60-62) Revised: May 2023 ©Portage College Paramedic Program Page 2 of 3   ©Portage College Paramedic Program Page 3 of 3