(FDA approved in bold)

• Acute ischemic stroke (AIS)
  
• Acute myocardial infarction (AMI)
  
• Pulmonary embolism (PE)
  
• Restoration of function to central venous access device

• Alteplase is a tissue plasminogen activator. It binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin, initiating a local fibrinolysis with little systemic effect

• Less than 1 hour, often earlier

• After administration, monitor in intensive care – preferably in an acute stroke or cardiac unit

• Alteplase is not always effective and has risks. After initial monitoring period in intensive care, continue standard AIS, AMI, or PE care

• Not combined with other agents. Use caution with patients already taking anticoagulants or antiplatelet medications

• Ensure no contraindications are present before administering drug. For all patients with suspected AIS with onset less than 3 hours prior, immediately type and screen, obtain CBC, glucose, coagulation tests, and ensure no intracranial bleeding (usually with head CT)