Alteplaza

When ATH:
B01AD02

Characteristic.

Glikoproteid, consisting of 527 amino acids. Synthesized by recombinant DNA technology.

Pharmacological action.
Thrombolytic.

Application.

Infarct infarction (during the first 6-12 hours), acute massive pulmonary embolism.

Contraindications.

Hypersensitivity, gyemorragichyeskii diatyez, concomitant use of anticoagulants, internal bleeding (incl. recently transferred), cerebrovascular accident (incl. in 6 monthly history), neoplasm with increased bleeding risk, aneurysms and vascular malformations, intracranial or spinal surgery within the previous 2 months, gemorragicheskaya retinopathy, period up 10 days after a severe injury, traumatic open heart massage, extensive surgery, delivery, puncture vessels with low pressure, incl. subclavian and jugular veins, severe uncontrolled hypertension, bacterial endocarditis, perikardit, acute pancreatitis, gastric ulcer and duodenal ulcer for 3 months after the exacerbation, hepatic failure, cirrhosis of the liver, portal hypertension, accompanied by esophageal varices, active hepatitis.

Restrictions apply.

Recently transferred minor injuries as a result of the biopsy, puncture vessels, i / m injection, cardiac massage and other conditions, accompanied by the risk of bleeding.

Pregnancy and breast-feeding.

Maybe, if the effect of therapy outweighs the potential risk to the fetus (experience of use in pregnancy is limited).

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Side effects.

Bleeding: outdoor (from the puncture site, damaged vessels, nose, right) and inner (in the digestive tract, urogenital tract, retroperitoneal space, CNS, incl. intracranial (1%), of parenchymal organs); arrhythmia (if successful recanalization of coronary arteries in patients with acute myocardial infarction), extremely rare — little by little an atherosclerotic or tromboticheskaja embolism, incl. kidney development of renal failure, nausea, vomiting, and low blood pressure (may be symptoms of myocardial infarction).

Cooperation.

The risk of bleeding is increased by the simultaneous use of coumarin derivatives, antiagregantov, heparin and other drugs, oppressing blood clotting.

Overdose.

Symptoms: lowering the concentration of fibrinogen and blood clotting factors, bleeding (surface, from the gastrointestinal tract, urinary and genital tract, parenchymal organs); retroperitoneal hematoma, CNS hemorrhage.

Treatment: introduction of fresh frozen plasma, fresh whole blood, plazmozameshchath solutions, Synthetic antifibrinolytics.

Dosing and Administration.

B /. The contents of bottle dissolved in water for injection to the concentration 1 mg / ml (the resulting solution can subsequently be further diluted with sterile 0,9% saline solution up to the minimum concentration 0,2 mg / ml).

Myocardial infarction prior to 6 h after the onset of symptoms for patients weighing more than 65 kg - 15 mg in/in bolusno, then 50 mg in the form of infusions over 30 mines and further 35 mg for 1 h to achieve total dose 100 mg. While designation through the 6-12 hours of the onset of symptoms is 10 mg in/in bolusno, then in the form of infusions 50 mg during the first 60 m and below 10 mg every 30 minutes before the total dose 100 mg for 3 no. In patients weighing less than 65 kg total dose should not exceed 1,5 mg / kg. Adjuvant therapy: appointment of acetylsalicylic acid (as soon as possible and in the first months after myocardial infarction) and heparin (on 24 h or longer): recommended bolusnoe in a dose 5000 U and then infuzionno in mode 1000 U / h. Treatment is carried out under the control of activated partial thromboplastin time (APTT), which should not exceed the original more than 1.5-2.5.

When pulmonary embolism: 10 mg in/in bolusno within 1-2 minutes and 90 mg in the form of infusions over 2 no, to achieve a total dose 100 mg. The total dose of body weight less than 65 kg should not exceed 1,5 mg / kg. Adjuvant therapy: if the APTT after administration of alteplase exceed the original less than 2 times, Heparin should be appointed or to continue treatment to them (under the supervision of APTT, which should not exceed more than the original 1.5-2.5 times).

Precautions.

It should be taken into account, that elderly patients may increase as the therapeutic efficacy, and the risk of intracranial hemorrhage (an evaluation of the ratio of expected benefits and potential risks). Experience with children is limited. At doses, exceeding 100 mg increases risk of bleeding vnutricerepnogo. In case of anaphylactic reactions should start and stop infusion symptomatically.

Cautions.

Simultaneously with the introduction of the drug recommended the appointment of acetylsalicylic acid and heparin. If you experience bleeding should stop administering.

Cooperation