How is alteplase administered in thrombolytic therapy for acute ischemic stroke (AIS)?

Updated: Aug 04, 2021
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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If there are no contraindications, start two peripheral IV lines, one for alteplase infusion and the other to manage any complications that may occur. The recommended dose of alteplase for AIS is 0.9 mg/kg (maximum, 90 mg) infused over 60 minutes, with 10% of the total dose administered as an initial IV bolus over 1 minute. [4, 59]

The patient must be admitted to a critical care area so that frequent neurologic assessments, blood pressure and cardiovascular monitoring can be carried out. The clinician must be ready to recognize and manage possible complications. The effectiveness of thrombolytic therapy in stroke is strongly correlated with strict patient selection within the inclusion and exclusion criteria.

No adjunctive therapies should be given along with alteplase for the management of AIS. Anticoagulants and antiplatelet agents may increase the risk of bleeding complications and are not recommended within 24 hours of alteplase administration.

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