How to use
should be administered as soon as possible after the thrombosis occurs.
In case of acute myocardial infarction, if 6 hours have elapsed since the onset of symptoms, first 15 mg of alteplase should be administered in/in boluso, then during the first 30 minutes in/in drip - 50 mg, then continue infusion and 35 mg should be administered for 1 hour. In patients with body weight <65 kg after the bolus injection of 15 mg and 30-minute infusion in a dose of 0.75 mg/kg (not more than 50 mg) continue infusion in a drip of 0.5 mg/kg (not more than 35 mg) for 1 hour.
If treatment is started within 6-12 h after the onset of myocardial infarction symptoms, first 10 mg of alteplase shall be given in/in bolusly, then 50 mg shall be administered in/in drip for 1 h, after which infusion shall continue at a rate of 10 mg in 30 min up to a maximum dose of 100 mg in 3 hours. In patients with body weight <65 kg the total dose should not exceed 1.5 mg/kg.
In pulmonary embolism, 10 mg of alteplase is usually administered in/in painfully for 1-2 min, then 90 mg in/in drip for 2 h. The total dose is 100 mg in 2 hours. In patients with body weight >65 kg, the total dose should not exceed 1.5 mg/kg.
Treatment in case of ischemic stroke should be started within 3 hours from the onset of symptoms; usually alteplase should be administered in a dose of 0.9 mg/kg (no more than 90 mg) in a drip for 1 hour, with 10% of the total dose administered at the beginning of infusion in a painful manner. The maximum dose of alteplase is 100 mg.
- Thrombolytic therapy alteplase of acute myocardial infarction (in the first 6-12 hours from the beginning of the disease).
- Thrombolytic therapy of ischemic stroke in the acute period (after exclusion of intracranial bleeding).
- Thrombolytic therapy for acute thromboembolism (including thromboembolism of the pulmonary artery).
Alteplase Contraindications Therapy for acute thromboembolism.
- Significant bleeding now or within the previous 6 months;
- Simultaneous administration of oral anticoagulants such as sodium warfarin (INR > 1.3);
- Any damage and diseases of the central nervous system in the history (including neoplasms, aneurysm, brain and spinal cord surgery;
- Intracranial (including subarachnoid) haemorrhage currently or in history; suspected hemorrhagic stroke;
- Severe uncontrollable arterial hypertension;
- Extensive surgical intervention or significant injury in the previous 10 days (including any injury in combination with this acute myocardial infarction), recent brain injury;
- Prolonged or traumatic cardiopulmonary resuscitation (> 2 minutes), delivery in the previous 10 days; recent puncture of a blood vessel inaccessible to pressure (e.g., subclavian or jugular vein);
- Severe liver diseases, including liver failure, cirrhosis, portal hypertension (including esophageal varicose veins) and active hepatitis;
- Hemorrhagic retinopathy, for example, in diabetes mellitus (vision disorders may indicate hemorrhagic retinopathy), other hemorrhagic eye diseases;
- Bacterial endocarditis;
- Acute pancreatitis;
- Confirmed gastric or duodenal ulcer disease within the last 3 months;
- Arterial aneurysms, arterial/ven developmental defects;
- neoplasms with increased risk of bleeding;
- Hypersensitivity to drug components.
- If the drug is used to treat acute myocardial infarction and pulmonary embolism, in addition to the above, there are the following additional contraindications:
- Stroke in the anamnesis.
- If you use the drug for the treatment of acute ischemic stroke, in addition to the above, there are the following contraindications:
- Start of symptoms of ischemic stroke more than 3 hours before the beginning of infusion, or lack of precise information about the time of onset of symptoms;
- Rapid improvement in acute ischemic stroke, or poor symptomatology at the time of infusion;
- Severe stroke, based on clinical data (e.g., NIHSS > 25) and/or appropriate imaging techniques;
- Seizure at the start of a stroke;
- Information on stroke or serious head injury suffered during the previous 3 months;
- Combination of previous stroke and diabetes mellitus;
- Use of heparin for 48 hours before the start of a stroke if the activated partial thromboplastin time (ACTT) is increased at this time;
- Antiagent use literally means joint inflammation but is typically the word used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. This booklet focuses on pain caused by two of the most common forms of arthritis, osteoarthritis and rheumatoid arthritis.