Thrombolytic Agents in Acute Myocardial Infarction

Page by: E.J. Mayeaux, Jr., M.D.
Louisiana State University Medical Center Shreveport, Louisiana

Administration of Thrombolytic Agents

1. Start two 18-g peripheral intravenous lines.

2. No ABGs or central lines may be used or started before treatment.

1. Streptokinase (Kabikinase, Streptase)
   1. Dilute two 750,000-unit vials of streptokinase with 5 ml of 5% dextrose in water.
   2. Gently swirl to dissolve.
   3. Add this dose of 1.5 million units to 150 mL of 5% dextrose in water.
   4. This should be infused over 60 minutes.
   5. Monitor for the first few hours for signs of anaphylaxis or allergic reaction. Infusion should be slowed if the blood pressure drops 25 mm Hg or terminated if asthmatic symptoms appear.
   6. Begin a 5,000- to 10,000-unit bolus dose of heparin followed by 1,000 units per hour approximately 3 to 4 hours after completion of streptokinase infusion or when partial thromboplastin time is < 100 seconds.
   7. Monitor prothrombin time, partial thromboplastin time, and fibrinogen levels during therapy.

   Alteplase, recombinant (tPA Activase)

1. 1. Dilute two 50-mg vials with sterile water for injection provided in the package.
   2. Gently swirl to dissolve.
   3. The total dose is 100 mg over 1.5 hours. (For patients who weigh < 65 kg, use 1.25 mg/kg.)
   4. Add this dose to a 100-mL bag of 0.9% sodium chloride for a total volume of 200 mL.
   5. Infuse 15 mg (30 ml) over 1 to 2 minutes.
   6. Infuse 50 mg (100 ml) over the remainder of the first 30 minutes.
   7. Begin a 5,000- to 10,000-unit bolus dose of heparin followed by continuous infusion of 1,000 units per hour.
   8. Infuse 35 mg over the next hour.
   9. Check partial thromboplastin time 3 to 4 hours after the end of the infusion.

Contraindications to Thrombolysis

• Absolute

• Active bleeding
• Possible Aortic dissection
• Prolonged CPR
• Head injury
• Central nervous system neoplasm
• Hemorrhagic retinopathy
• Pregnancy
• Streptokinase or anistreplase allergy
• Blood pressure > 200/120 mm Hg after sublingual nifedipine
• Prior cerebral bleeding
• Trauma or surgery within 2 weeks
• Relative
• Trauma/surgery longer than 2 weeks
• Chronic severe hypertension
• Active peptic ulcer disease
• History of cerebrovascular accident
• Bleeding diathesis
• Anticoagulant medication
• Liver dysfunction
• Previous Streptokinase / Alteplase

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