indication

For management of acute myocardial infarction, acute ischemic strok and for lysis of acute pulmonary emboli

pharmacology

Alteplase binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin. It also produces limited conversion of plasminogen in the absence of fibrin.

mechanism of action

Alteplase binds to fibrin rich clots via the fibronectin finger-like domain and the Kringle 2 domain. The protease domain then cleaves the Arg/Val bond in plasminogen to form plasmin. Plasmin in turn degrades the fibrin matrix of the thrombus, thereby exerting its thrombolytic action.

drug interactions

Ginkgo biloba: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Nitroglycerin: IV nitroglycerin may decrease the effect of alteplase.

Ticlopidine: Increased bleeding risk. Monitor for signs of bleeding.