Alteplase

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Alteplase
Names
Trade namesActivase, Actilyse, others
Other namest-PA, rt-PA
Clinical data
Pregnancy
category
  • US: C (Risk not ruled out)[1]
Defined daily dose0.1 gram[2]
External links
AHFS/Drugs.comMonograph
Legal
License data
Legal status
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).[3] It is given by injection into a vein or artery.[3]

Common side effects are bleeding including intracranial bleeding and GI bleeding.[3] Other side effects may rarely include allergic reactions.[3] It is not recommended in those allergic to gentamicin.[4] Safety of use in pregnancy is unclear.[1] Alteplase is a manufactured form of tissue plasminogen activator.[3] It works by converting plasminogen to plasmin in a blood clot.[3]

Alteplase was approved for medical use in the United States in 1987.[3][5] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[6] In the United Kingdom it costs about £864 per treatment as of 2018.[4] In the United States this amount costs about US$9,197 as of 2019.[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]

Dosage

The defined daily dose is 0.1 gram (parenteral)[2]

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,[6] having been added in 2019.[10] In the United Kingdom it costs about £864 per treatment as of 2018.[4] In the United States this amount costs about US$9,197 as of 2019.[7]

References

  1. 1.0 1.1 "Alteplase Use During Pregnancy". Drugs.com. Retrieved 12 November 2019.
  2. 2.0 2.1 "WHOCC - ATC/DDD Index". www.whocc.no. Retrieved 10 September 2020.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 "Alteplase Monograph for Professionals". Drugs.com. Retrieved 11 November 2019.
  4. 4.0 4.1 4.2 British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 216. ISBN 9780857113382.
  5. "Activase: FDA-Approved Drugs". U.S. Food and Drug Administration (FDA). Retrieved 4 January 2020.
  6. 6.0 6.1 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.
  7. 7.0 7.1 "Activase Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved 12 November 2019.
  8. 8.0 8.1 "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: 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

External sites:
Identifiers: