What is the FDA recommended regimen of alteplase for thrombolytic therapy of pulmonary embolism (PE)?

Updated: Dec 31, 2017
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

The FDA-approved alteplase regimen for PE is 100 mg as a continuous infusion over 2 hours. A 15-mg bolus is administered first, followed by 85 mg administered over 2 hours. Heparin drip must be discontinued during alteplase infusion.

Some centers prefer to use an accelerated 90-minute regimen that appears to be faster-acting, safer, and more efficacious than the 2-hour infusion. For patients weighing less than 67 kg, the drug is administered as a 15-mg IV bolus followed by 0.75 mg/kg over the next 30 minutes (maximum, 50 mg) and then 0.50 mg/kg over the next 60 minutes (maximum, 35 mg). For patients weighing more than 67 kg, 100 mg is administered as an 15-mg IV bolus followed by 50 mg over the next 30 minutes and then 35 mg over the next 60 minutes.


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