Background Information
Alteplase is a serine protease which has the property of fibrin-enhanced conversion of plasminogen to plasmin. Alteplase binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin initiating local fibrinolysis with minimal systemic effects. Alteplase is cleared rapidly from circulating plasma with an initial half-life of less than 5 minutes and the clearance is mediated primarily by the liver.
Alteplase indications include the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized …show more content…
The primary focus was on appropriate use as defined by use only in patients meeting inclusion criteria of the Palms West Hospital protocol, administration within the appropriate window, correct weight-based dosing and bleeding adverse event as define by a drop in baseline hemoglobin of ≥ 2g/dL over a 24 hour period. The patient’s age, gender, race, baseline blood pressure, prescribing physician, and NIH score was also …show more content…
Current guidelines recommend an alteplase dose of 0.9 mg/kg, up to a maximum dose of 90 mg, for patients weighing ≥100 kg. Upon reviewing the data, 20 out of 21 patients who received alteplase were dose correctly based on baseline weight gathered upon arrival at the emergency department (ED). One patient received more than 10% of the recommended weight-based calculated dose but fortunately did not show any adverse effects. Upon further investigation, there was a significant difference between the baseline weights documented at the ED versus the weights documented when the patient was transferred to the intensive care unit (ICU) over a 24 hour period. Differences in weight could have been caused by the lack of scales (stretcher) in the ED or weights being reported by patient or family
Alteplase is a serine protease which has the property of fibrin-enhanced conversion of plasminogen to plasmin. Alteplase binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin initiating local fibrinolysis with minimal systemic effects. Alteplase is cleared rapidly from circulating plasma with an initial half-life of less than 5 minutes and the clearance is mediated primarily by the liver.
Alteplase indications include the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability. Treatment should be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized …show more content…
The primary focus was on appropriate use as defined by use only in patients meeting inclusion criteria of the Palms West Hospital protocol, administration within the appropriate window, correct weight-based dosing and bleeding adverse event as define by a drop in baseline hemoglobin of ≥ 2g/dL over a 24 hour period. The patient’s age, gender, race, baseline blood pressure, prescribing physician, and NIH score was also …show more content…
Current guidelines recommend an alteplase dose of 0.9 mg/kg, up to a maximum dose of 90 mg, for patients weighing ≥100 kg. Upon reviewing the data, 20 out of 21 patients who received alteplase were dose correctly based on baseline weight gathered upon arrival at the emergency department (ED). One patient received more than 10% of the recommended weight-based calculated dose but fortunately did not show any adverse effects. Upon further investigation, there was a significant difference between the baseline weights documented at the ED versus the weights documented when the patient was transferred to the intensive care unit (ICU) over a 24 hour period. Differences in weight could have been caused by the lack of scales (stretcher) in the ED or weights being reported by patient or family