HWN Suggests

Thrombolytic Agents of Choice for STEMI

Alteplase is a recombinant human tPA that is widely available in the United States. It is fibrin-specific and has FDA-approved indications for STEMI, pulmonary embolism, and acute ischemic stroke. Although alteplase has two FDA-approved dosing strategies for STEMI (90-minute infusion vs 3-hour infusion), the 90-minute infusion (also known “accelerated infusion alteplase”) is more commonly used and recommended by the AHA/ACCF and ESC guidelines due to increased all-cause mortality seen with the 3-hour alteplase infusion (also referred to as “non-accelerated infusion alteplase"}.

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 Formulary Guidance: Thrombolysis

Alteplase is the fibrin specific thrombolytic of choice in the trust for STEMI Percutaneous coronary intervention is preferred over fibrinolytic therapy in the treatment of STEMI to restore patency to an occluded coronary artery. Fibrinolysis should only be offered to people presenting within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes.

 Thrombolysis in Acute Myocardial Infarction: t-PA for Everyone?

t-PA is a superior thrombolytic agent in comparison with streptokinase. This superiority has been demonstrated in all trials in which angiographie patency has been measured early after drug administration. In general at 90 minutes, patency can be expected in 75% of patients who receive t-PA but in only 50% of those who receive streptokinase,10 although a "catch-up phenomenon" occurs so that by 3 hours the rates for both are approximately 70 to 75%.

Articles of Interest

Alteplase: A Tissue Plasminogen Activator for Acute Myocardial Infarction

Tissue plasminogen activator is effective at opening clotted coronary arteries in approximately 70 percent of AMI patients and has been shown to be approximately twice as effective as SK in one U.S. trial. Although there is considerable evidence of efficacy with t-PA, data evaluating the influence of t-PA on mortality are limited, but suggest a reduction to five percent.

Effectiveness of t-PA in Patients with Acute Myocardial Infarction

This study indicated that increasing age, obesity, diabetes mellitus (DM), and delay in reaching hospital after onset of ischemic chest pain considered as predictors for poor response to t-PA infusion among patients with STEMI. BMI has no significant consideration but smokers patients had been associated with better response to t-PA.

Thrombolytic Use for STEMI: What ED Clinicians Should Know

Alteplase is a recombinant human tPA that is widely available in the United States. It is fibrin-specific and has FDA-approved indications for STEMI, pulmonary embolism, and acute ischemic stroke. Although alteplase has two FDA-approved dosing strategies for STEMI (90-minute infusion vs 3-hour infusion), the 90-minute infusion (also known “accelerated infusion alteplase”) is more commonly used and recommended by the AHA/ACCF and ESC guidelines due to increased all-cause mortality seen with the 3-hour alteplase infusion (also referred to as “non-accelerated infusion alteplase}.

What is the Difference Between tPA and TNK

The main difference between tPA and TNK is that tPA, or tissue plasminogen activator, is one of the essential components of the dissolution of blood clots, whereas TNK is a genetically modified form of tissue plasminogen activator.

Resources

Activase (Alteplase)

Activase® is an effective treatment option for Acute Myocardial Infarction (AMI)

StatPearls

Alteplase (tPA) is a powerful thrombolytic agent used in the lysis of acute thromboembolism. FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST-segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re-establishment of patency in occluded intravenous (IV) catheters. There are also off-label indications.