Alteplase Flashcards
1
Q
tPA (MOA)
A
MOA: initiates fibrinolysis by binding to fibrin and converts plasminogen to plasmin
2
Q
tPA Dose
A
0.9 mg/kg (max: 90mg)
Bolus: 10% over 1 min
Infusion: 90% over 1 hr
3
Q
tPA Exclusion
A
- HX of previous ICH
- SBP > 185
- BG <50
- prior ischemic stroke within 3 months
- head trauma within 3 months
- pregnancy
4
Q
tPA Inclusion
A
- age 18+ yrs old
- administer 45 min or less from ED arrival
- last known well < 4.5 hrs
- ischemic stroke
- BP < 185/110
- following infusion 24hr 180/105
5
Q
TPA reversal
A
- Stop alteplase infusion
- CBC, PT (INR), aPTT, fibrinogen level, type and cross match
- Head CT
- Cryoprecipitate (includes fibrinogen, FVIII, von Willebrand Factor): 10 units infused 10-30 min (onset 1 h, peaks in 12h); administer 2nd dose if fibrinogen level <200 mg/dL
- extract rich in a blood-clotting factor obtained as a residue from when FFP is thawed
- cryo»_space; FFP bc larger volume of FFP needs to be transfused due to lower concentrations of fibrinogen
- Tranexamic acid 1000 mg IV infused over 10 min —> competitively bind to plasminogen and block its conversion to plasmin; resulting in inhibition of fibrinolysis and inhibits proteolytic activity of plasmin
OR e-aminocaproic acid 4-5g over 1 hr followed by 1 g IV until bleeding is controlled (peak onset is 3 h) - Supportive therapy (BP management, ICP, CPP, MAP, temp, glucose control)
6
Q
Cryoprecipitate MOA/dosing
A
includes fibrinogen, FVIII, von Willebrand Factor
extract rich in a blood-clotting factor obtained as a residue from when FFP is thawed
- DOSING: 10 units infused 10-30 min
- onset 1 h, peaks in 12h
- administer 2nd dose if fibrinogen level <200 mg/dL
- cryo»_space; FFP bc larger volume of FFP needs to be transfused due to lower concentrations of fibrinogen
7
Q
Tranexamic acid MOA/Dosing
A
competitively bind to plasminogen and block its conversion to plasmin; resulting in inhibition of fibrinolysis and inhibits proteolytic activity of plasmin
- 1000 mg IV infused over 10 min
