Thursday November 2, 2006
tPA in PE

Q; What is the dose of tissue plasminogen activator (tPA) in PE ?


A; The approved dose of tPA (tissue plasminogen activator) from FDA is 100 mg as a continuous infusion over 2 hours. tPA administration should be followed with heparin infusion. In situations where you don't have luxury of even waiting for 2 hours and surgery backup is not available for thrombectomy, dose of 0.6 mg/kg over 15 minutes may be given.

Another thrombolytic which is not approved but may be use is Reteplase with single dose of 10 units as bolus. In code situation 20 units may be given as a single bolus.


If first round of thrombolysis doesn't improve clinical signs, second dose may be repeated but one recent trial (see related pearl below) showed that rescue surgical embolectomy is better than repeat thrombolysis in patients who do not respond to first dose of thrombolysis.



Related previous pearl:

What if even thrombolysis fails in massive PE ?