Alteplase (recombinant tissue plasminogen activator, tPA) is a potent intravenous fibrinolytic (“clot buster”) used for everything from acute ischemic strokes and clearing central line ports (“Cathflo”, a total life saver!) to hemodynamically unstable pulmonary embolism (PE) and even ST elevation myocardial infarctions (STEMIs – “heart attacks”).

Although the classic indication for alteplase is for the treatment of ischemic strokes within 4.5 hours of the onset of symptoms, I’ve most commonly seen it used for hemodynamically unstable PEs defined by a high index of suspicion for pulmonary clots, hypotension, or overt shock-like symptoms. In these cases, alteplase is administered systemically vs catheter-directed into the pulmonary artery.

Regardless of the indication, the incidence of bleeding is high! Have a low suspicion to investigate changes in mental status, drops in hematocrit, etc. with the relevant physical exam and imaging.

Drop a comment with questions! 🙂

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