According to the American Stroke Association the most promising treatment for ischemic stroke is the clot-busting drug tPA (tissue plasminogen activator), given in the first three hours after the onset of symptoms. A 2011 study found that the typical cost of treatment with tPA is $2,200. The medication, called tPA, or tissue plasminogen activator, can dissolve the blood clots that cause most strokes, often sparing patients from devastating brain damage. TPA is a thrombolytic or a “Clot Buster” drug. This clot buster is used to break-up the clot that is causing a blockage or disruption in the flow of blood to the brain and helps restore the blood flow to the area of the brain. It is given by intravenous (IV), not by mouth. What tests are required? Traditionally, the medication is used to dissolve blood clots in stroke and heart patients. The doctors said tPA carries a risk of bleeding in the brain when used for non-stroke indications. Alteplase is an injectable drug, given directly into a vein, that is used to treat conditions caused by arterial blood clots including heart attacks, strokes, chest pain at rest (unstable angina), blood clots in the lungs (pulmonary thrombosis or embolus), and other less common conditions involving blood clots.

Generic Name: alteplase (AL te plase)
Brand Name:Activase, Cathflo Activase
Dosage Forms: injectable powder for injection (2 mg); intravenous powder for injection (100 mg; 50 mg)

What is alteplase?

Alteplase is a thrombolytic (THROM-bo-LIT-ik) drug, sometimes called a 'clot-busting' drug. It helps your body produce a substance that dissolves unwanted blood clots.

Alteplase is used to treat a stroke caused by a blood clot or other obstruction in a blood vessel. Alteplase is also used to prevent death from a heart attack (acute myocardial infarction).

Alteplase is also used to treat a blood clot in the lung (pulmonary embolism).

Alteplase is also used to dissolve blood clots that have formed in or around a catheter placed inside a blood vessel. This improve the flow of medicines injected in through the catheter, or blood drawn out through the catheter.

Alteplase may also be used for purposes not listed in this medication guide.

Important Information

Alteplase increases your risk of severe or fatal bleeding, especially from a surgical incision, or from the skin where a needle was inserted. Seek emergency help if you have any bleeding that will not stop.

Before taking this medicine

You should not be treated with alteplase if you are allergic to it, or if you have:

• active bleeding inside your body;

• a brain tumor or aneurysm (dilated blood vessel);

• a history of head injury or surgery on your brain or spinal cord within the past 3 months; or

• severe or uncontrolled high blood pressure;

• a bleeding or blood clotting disorder such as hemophilia;

• bleeding inside your brain (if you are receiving alteplase to treat a stroke); or

• a recent history of stroke (if you are receiving alteplase for pulmonary embolism).

If possible before you receive alteplase, tell your doctor if you have ever had:

• any type of stroke;

• bleeding in your brain, stomach, intestines, or urinary tract;

• high blood pressure;

• heart problems;

• an infection of the lining of your heart (also called bacterial endocarditis);

• a serious injury or major surgery;

• severe bruising or infection around a vein where an IV was placed;

• an organ biopsy;

• eye problems caused by diabetes;

• liver or kidney disease; or

• if you are pregnant or breastfeeding.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received alteplase.

How is alteplase given?

Alteplase is given as an infusion into a vein. A healthcare provider will give you this injection.

Alteplase is usually given within 3 hours after the first signs of stroke or heart attack symptoms. Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely.

You will also be watched closely for several hours after receiving alteplase, to make sure you do not have an allergic reaction to the medication.

When used to clear blood clots from a catheter, alteplase is given in 1 or 2 doses.

Your doctor may prescribe a blood thinner or other medication to help prevent future blood clots. Carefully follow all dosing instructions. These medications can make it easier for you to bleed, even from a minor injury.

What happens if I miss a dose?

Because you will receive alteplase in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid after receiving alteplase?

Ask your doctor before taking aspirin or ibuprofen (Motrin, Advil) shortly after you have received alteplase. These medications can increase your risk of bleeding.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Alteplase side effects

Get emergency medical help if you have signs of an allergic reaction:hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Alteplase increases your risk of bleeding, which can be severe or fatal. Call your doctor or seek emergency medical attention if you have bleeding that will not stop. Bleeding may occur from a surgical incision, or from the skin where a needle was inserted during a blood test or while receiving injectable medication. You may also have bleeding on the inside of your body, such as in your stomach or intestines, kidneys or bladder, brain, or within the muscles.

Call your doctor or get emergency medical help if you have signs of bleeding, such as:

• sudden headache, feeling very weak or dizzy;

• bleeding gums, nosebleeds;

• easy bruising;

• bleeding from a wound, incision, catheter, or needle injection;

• bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

• red or pink urine;

• heavy menstrual periods or abnormal vaginal bleeding; or

• sudden numbness or weakness (especially on one side of the body), slurred speech, problems with vision or balance.

Also call your doctor at once if you have:

• chest pain or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;

• swelling, rapid weight gain, little or no urination;

• severe stomach pain, nausea, and vomiting;

• darkening or purple discoloration of your fingers or toes;

• very slow heartbeats, shortness of breath, feeling light-headed;

• sudden severe back pain, muscle weakness, numbness or loss of feeling in your arms or legs;

• increased blood pressure--severe headache, blurred vision, pounding in your neck or ears, anxiety, nosebleed; or

• pancreatitis--severe pain in your upper stomach spreading to your back, nausea and vomiting.

Bleeding is the most common side effect of alteplase.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect alteplase?

Tell your doctor about all your other medicines, especially:

• any medication used to treat or prevent blood clots;

• a blood thinner (heparin, warfarin, Coumadin, Jantoven); or

• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may affect alteplase, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2021 Cerner Multum, Inc. Version: 3.01.

More about alteplase

• During Pregnancy or Breastfeeding

Consumer resources

Other brands:Activase, Cathflo Activase

Professional resources

Related treatment guides

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Thrombolytic medicines are approved for the emergency treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.

Ideally, you should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital for treatment.

HEART ATTACKS

A blood clot can block the arteries to the heart. This can cause a heart attack, when part of the heart muscle dies due to a lack of oxygen being delivered by the blood.

Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle. Thrombolytics can stop a heart attack that would otherwise be larger or potentially deadly. Outcomes are better if you receive a thrombolytic drug within 12 hours after the heart attack starts. But the sooner treatment begins, the better the results.

The drug restores some blood flow to the heart in most people. However, the blood flow may not be completely normal and there may still be a small amount of muscle damaged. Further therapy, such as cardiac catheterization with angioplasty and stenting, may be needed.

Your health care provider will base the decisions about whether to give you a thrombolytic medicine for a heart attack on many factors. These factors include your history of chest pain and the results of an ECG test.

Other factors used to determine if you are a good candidate for thrombolytics include:

• Age (older people are at increased risk of complications)
• Sex
• Medical history (including your history of a previous heart attack, diabetes, low blood pressure, or increased heart rate)

Generally, thrombolytics may not be given if you have:

• A recent head injury
• Bleeding problems
• Bleeding ulcers
• Pregnancy
• Recent surgery
• Taken blood thinning medicines such as Coumadin
• Trauma
• Uncontrolled (severe) high blood pressure

STROKES

Most strokes are caused when blood clots move to a blood vessel in the brain and block blood flow to that area. For such strokes (ischemic strokes), thrombolytics can be used to help dissolve the clot quickly. Giving thrombolytics within 3 hours of the first stroke symptoms can help limit stroke damage and disability.

The decision to give the drug is based upon:

• A brain CT scan to make sure there has not been any bleeding
• A physical exam that shows a significant stroke
• Your medical history

As in heart attacks, a clot-dissolving drug isn't usually given if you have one of the other medical problems listed above.

Tpa Medication Dosage

Thrombolytics are not given to someone who is having a stroke that involves bleeding in the brain. They could worsen the stroke by causing increased bleeding.

RISKS

Bleeding is the most common risk. It can be life threatening.

Minor bleeding from the gums or nose can occur in approximately 25% of people who receive the drug. Bleeding into the brain occurs approximately 1% of the time. This risk is the same for both stroke and heart attack patients.

If thrombolytics are felt to be too dangerous, other possible treatments for clots causing a stroke or heart attack include:

• Removal of the clot (thrombectomy)
• A procedure to open narrowed or blocked blood vessels that supply blood to the heart or the brain

CONTACT A HEALTH CARE PROVIDER OR CALL 911

Tpa Clot Buster

Heart attacks and strokes are medical emergencies. The sooner treatment with thrombolytics begins, the better the chance for a good outcome.

Tissue plasminogen activator; TPA; Alteplase; Reteplase; Tenecteplase; Activase thrombolytic agent; Clot-dissolving agents; Reperfusion therapy; Stroke - thrombolytic; Heart attack - thrombolytic; Acute embolism - thrombolytic; Thrombosis - thrombolytic; Lanoteplase; Staphylokinase; Streptokinase (SK); Urokinase; Stroke - thrombolytic therapy; Heart attack - thrombolytic therapy; Stroke - thrombolysis; Heart attack - thrombolysis; Myocardial infarction - thrombolysis

Bohula EA, Morrow DA. ST-elevation myocardial infarction: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 59.

Crocco TJ, Meurer WJ. Stroke. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 91.

Jaffer IH, Weitz JI. Antithrombotic drugs. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 149.

Tpa Medication Contraindications

O'Gara PT, Kushner FG, Ascheim DD, et al. 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. 2013;127(4):529-555. PMID: 23247303 pubmed.ncbi.nlm.nih.gov/23247303/.

Tpa Clot Medication

Updated by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.