AMI. For the first 6 hours, intravenously, bolus at a dose of 15 mg for 1-2 minutes, followed by infusion at a dose of 50 mg for 30 minutes and 35 mg for 60 minutes before reaching the maximum dose (100 mg). Patients weighing less than 65 kg - intravenously bolus at a dose of 15 mg and 0.75 mg / kg for 30 minutes (maximum - 50 mg); then - infusion of 0.5 mg / kg for 60 minutes (maximum - 35 mg). After 6-12 hours after the onset of symptoms, the drug is administered intravenously bolus in a dose of 10 mg, and 50 mg - infuzionno during the first hour, and then at a dose of 10 mg for 30 minutes (up to a maximum dose of 100 mg for 3 hours). For patients with a body weight of less than 65 kg, the drug is prescribed in a dose not exceeding 1.5 mg / kg.
At the same time, acetylsalicylic acid is administered and heparin sodium. Acetylsalicylic acid - 160-300 mg / day after the onset of symptoms for several months; heparin sodium - before the start of thrombolytic therapy intravenously bolus in a dose of 5 thousand ME, then - 1 thousand each.ME / h, taking into account the parameters of APTT (activated partial thromboplastin time), measured several times (the values should be 1.5-2.5 times higher than the initial ones).
Acute massive thromboembolism of the pulmonary artery in combination with unstable hemodynamics. Intravenous bolus in a dose of 10 mg for 1-2 minutes, then for 90 mg intravenously for 2 hours. The total dose of the drug in patients weighing less than 65 kg should not exceed 1.5 mg / kg. If the PV exceeds the original value by less than 2 times, it is simultaneously assigned heparin sodium (under the control of APTTV). With massive thromboembolism of the pulmonary artery with unstable hemodynamics, the drug acts in the same way as streptokinase. The introduction of alteplase in a total dose of 100 mg for 2 hours is comparable with the action of reteplase, streptokinase at a dose of 1.5 million IU for 2 hours, urokinase at a dose of 1 million ED bolus for 10 min (then - 2 million units intravenously for 2 h) and more effective than the intravenous drip of sodium heparin at 1750 IU / h. In the latter case, side effects often occur.
Acute ischemic stroke - thrombolysis (including alteplase 0.9 mg / kg to 90 mg in 100 ml of 0.9% sodium chloride, 10% dose in the form of a bolus,the rest - intravenously for 1 hour; alteplase 0.85 mg / kg intravenously for 60 min in the first 90 min and 91-180 min after the onset of the disease); alteplase (recombinant tissue plasminogen activator) 1.1 mg / kg to 100 mg intravenously, 10% dose in the form of a bolus, the rest intravenously for 1 hour;
With topical application in the case of thrombosis of the peripheral arteries of the lower extremities, the alteplase is superior to urokinase. With thrombosis of the cerebral arteries, the introduction of 2 million units / day of alteplase has advantages over intravenous administration of 60,000 U / day of urokinase for 7 days.
Use in children
Efficiency and safety have not been studied.
With intravascular thrombosis, the drug is administered intravenously strontaneously (in sterile water for injection until a solution with a concentration of 1 mg / ml) or drip (in a 0.9% solution of sodium chloride, until the concentration reaches 200 μg / ml). Do not dilute the drug with dextrose. Newborn drug is administered at 100-500 μg / kg per hour for 3-6 hours; children aged 1 month to 18 years - 100-500 μg / kg per hour for 3-6 hours (maximum daily dose - 100 mg). Before prescribing a second course, ultrasound monitoring of the response to the first course is necessary.
With occlusion of arteriovenous shunts or catheters for children aged 1-18 months, the drug is injected directly into the catheter in a dose of no more than 2 ml (depending on the type of catheter) of a solution with a concentration of 1 mg / ml; The lysate is aspirated after 4 hours, after which the catheter is washed with 0.9% sodium chloride solution. The use of the drug for thrombosis of the arteries or veins in newborns is not known.