Alteplase

Chemical name

Fabric plazminoguena activator (human protein dwuhtsepochechny woven type)

Gross

C2569-H3894-N746-O781-S40

Characteristics

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

Of drugs

The drugs-tromboliticescoe. Activated when connecting to fibrinom and stimulates transformation in plazminoguena plazmin. T_1/2 is 4.5 min. Metabolised in the liver. Is oxygen bunch fibrina.

Indications

Myocardial infarction (in the first 12 hours), the acute massive tromboembolia pulmonary artery.

Restrictions on the use of

Recently, over a trauma as a result of biopsy, Puncture receptacles in / m injections, heart massage and other conditions associated with the risk of bleeding.

Pregnancy and lactation

Perhaps if the effect of therapy outweighs the potential risk to the fetus (experience with the application of pregnancy limited).

Contraindications

Diates bloody, simultaneous anti proximity, internal bleeding (including recently transferred), the cerebral circulation (including 6 month history), neoplasm with increased risk of bleeding, and anevrizma deformity receptacles intrakraniale or spinale surgery within two preceding months, haemorrhagic retinopathy until 10 days after severe trauma, traumatic open heart massage, extensive surgery, childbirth, Puncture pressure to low pressure, including podklucicna and jugular veins, severe uncontrolled arterial hypertension, bacterial endocardit, pericardit, acute pancreatitis, a disease hospital of stomach and duodenal ulcer in the three months following the deterioration, liver failure, cirrhosis, portal hypertension, accompanied varikoznam vein extensions oesophagus, active hepatitis.

Side-Effects

Bleeding : physical (from the place Puncture damaged receptacles nose, gums) and internal (in the stomach, mochepolovom intestines retroperitonealnom space, CNS, including bleeding (1%), of parenchymatous organs); Already (with successful recanalization of coronary arteries in patients with acute myocardial infarction), it is rarely or holesterinova trombotical embolism, incl. kidney to the development of kidney failure, nausea, vomiting and loss of AD (can be symptoms of myocardial infarction).

Specific guidance

At the same time, with the introduction of the drug recommended the appointment of acetylsalicylic acid and heparin. If there is bleeding should stop introduction.

Patient interaction

The risk of hemorrhage increases while using coumarin derivatives, antiagregantov, heparin and other drugs oppressive out blood.

Overdosing

Symptoms : low concentrations fibrinoguena and factors such as blood clotting, bleeding (surface of the digestive tract, urinary and sexual tract, parenchymatous organs); Retroperitoneale bruises gemorragii in Zns.lechenie : a frozen plasma, fresh whole blood, plazmozameshchath solutions synthetic antifibrinolitikov.

Precautions

It should be borne in mind that older patients may increase the therapeutic efficacy, and the risk of bleeding vnutricerepnogo (an evaluation of the ratio of expected benefits and potential risks). The experience of the children is limited. When doses exceeding 100 mg increased risk of bleeding vnutricerepnogo. In the event of a reaction anaphylacticescoy should stop infuziu and begin simptomaticescuu therapy.

Dosing and Administration

B / 386/1989 The contents of bottle dissolved in water for injection to the concentration of 1 mg / ml (from the solution may in the future be further divorced sterile 0.9% saline solution up to the minimum concentration of 0.2 mg / ml). In myocardial infarct until 6900 after symptom patients weighing more than 65 kg to 15 mg in / in bolusno, then 50 mg in the form of infusions within 30 minutes and the 35 mg within 1 h until a total dose of 100 mg. In appointing six hours after the onset of symptoms, 10 mg in / in bolusno, then in the form of infusions 50 mg in the first 60 minutes and further to 10 mg every 30 minutes up to a total dose of 100 mg for 3 hours In patients weighing less than 65 kg total dose should not exceed 1.5 mg / kg Supportive therapy : appointment of acetylsalicylic acid (as soon as possible and in the first months after myocardial infarction), and heparin (24 hours or more) : to bolusnoe introduction to the dose of 5000 U, and then infuzionno in the 1000 U / h. Treatment of a controlled activated partial tromboplastinovogo time (ACTV), which exceed the original no more than 1.5-2.5 Raza.pri embolism pulmonary artery : 10 mg in / in bolusno within 1-2 minutes, and 90 mg in the form of infusions for two hours, until a total dose of 100 mg. The total dose in the body mass index less than 65 kg should not exceed 1.5 mg / kg Supportive therapy : if ACTV after Aktilise exceed original least twice, should appoint heparin or continue treating them (under the supervision of ACTV, which should not exceed the original more than 1.5-2.5 times).

Directory → Gematotropona funds → Fibrinolitiki → Alteplase