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Alteplase Dosing

Low Dose Systemic Thrombolysis

 

  • Alteplase 0.03-0.06 mg/kg/hr x 24 hours (max hourly dose 2 mg/hr)
    • If on heparin: decrease heparin dose to 5-10 units/kg/hr

    • If on direct thrombin inhibitor (DTI), decrease rate by 50%

    • Heparin and/or DTI lab monitoring IS NOT required while receiving alteplase

 

Standard Dose Systemic Thrombolysis

 

  • Alteplase 0.1-0.6 mg/kg/hr x 6 hrs
  • Adult dosing for pts > 16 yrs and > 60 kg: alteplase 100 mg over 2 hrs IV (if no concurrent anticoagulation therapy)

 

Catheter Directed Thrombolysis

 

  •  Alteplase 0.1-0.3 mg/kg (max dose 10 mg) bolus followed by 0.01-0.03 mg/kg/hr (max 2 mg/hr) x 24-72 hrs
  •  Administer heparin at 10 units/kg/hr or decrease direct thrombin inhibitor rate by 50%

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.