Mechanism of Action

• Local fibrinolysis by binding to fibrin, converts entrapped plasminogen to plasmin

Half-Life

• 5 minutes

Metabolism

• Primarily Hepatic

Dosing – Adult

• I.V. Dosing
  • Acute massive PE
    • 100 mg over 2 hours; may be administered as a 10 mg bolus followed by 90 mg over 2 hours
  • STEMI
    • >67 kg: Total dose: 100mg over 1.5 hrs; administered as a 15 mg I.V. bolus over 1-2 min, then 50 mg over 30 min, then 35 mg over 1 hr. Max. total dose: 100 mg.
    • ≤67 kg: 15mg I.V. bolus over 1 to 2 min.followed by 0.75 mg/kg (not to exceed 50 mg) over 30 min.,then 0.5 mg/kg (not to exceed 35 mg) over 1 hr. Max. total dose: 100 mg
  • CVA
    • <100 kg: 0.9 mg/kg actual body weight, max dose of 90mg. Give 10% of dose as I.V. bolus over one min, infuse remainder over 1 hr.
    • <100 kg: 9mg bolus, 81 mg over 1 hr.

Dosing – Pediatric

• Bolus: none
• Maintenance: 0.5 mg/kg/hr continuous infusion for 6 hours. Administer concurrently with low-dose UFH at 10 IU/kg/hr to prevent further thrombus formation*

Monitoring

• PT
• APTT

* If previously on UFH reduce infusion rate 30 min prior to rt-PA. Increase UFH rate to full dose 30 min after completion of a 6-hr infusion of rt-PA.