What’s the Code Dose of tPA?
Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses?
In the rare situation where fibrinolytics may be indicated in cardiac arrest from PE or Acute Myocardial Infarction (AMI), what’s the dose?
|Kurkciyan et al.1||Retrospective cohort||PE||Alteplase||100 mg (either two 50 mg boluses OR 15 mg bolus followed by 85 mg over 90 min)|
|Ruiz-Bailen et al.2||Case series (6 pts)||PE||Alteplase||50 mg bolus, repeat 50 mg in 30 min|
|Janata et al.3||Retrospective cohort||PE||Alteplase||0.6-1.0 mg/kg bolus (up to 100 mg)|
|Sharifi et al.4||Case series (23 pts)||PE||Alteplase||50 mg bolus|
|Lederer et al.5||Retrospective cohort||AMI||Alteplase||100 mg (15 mg followed by 85 mg over 90 min)|
|Ruiz-Bailen et al.6||Retrospective cohort||AMI||Alteplase||100 mg (either two 50 mg boluses OR 15 mg bolus followed by 85 mg over 90 min)|
|Schreiber et al.7||Retrospective cohort||AMI||Alteplase||100 mg (15 mg followed by 85 mg over 90 min)|
|Kurkciyan et al.8||Retrospective cohort||AMI||Alteplase||100 mg (15 mg followed by 85 mg over 90 min)|
|Bottiger et al.9||Prospective observational||Nontraumatic cardiac arrest||Alteplase||50 mg bolus, repeat 50 mg in 30 minutes|
|Abu-Laban et al.10||RCT||Cardiac arrest from any cause||Alteplase||100 mg over 15 min|
|Fatovich et al.11||RCT||Cardiac arrest from any cause||Tenecteplase||50 mg bolus|
|Bozeman et al.12||Prospective cohort||Nontraumatic cardiac arrest||Tenecteplase||0.5 mg/kg bolus|
|Bottiger et al.13||RCT||Cardiac arrest from any cause||Tenecteplase||0.5 mg/kg bolus|
|* Table includes only studies which fibrinolytic dose/administration is clearly specified.|
Take Home Points
- The dose of tPA in cardiac arrest is somewhere between 50-100 mg given as a bolus +/- infusion.
- According to the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, “Ongoing CPR is not an absolute contraindication for fibrinolysis.”
- Some studies suggest allowing 15 minutes of CPR for drug to work.
- Evidence is ‘best’ for PE; data does NOT support for undifferentiated cardiac arrest.
- Anticoagulants, such as heparin, were used in most studies along with the fibrinolytic.
Last updated: Aug 14, 2016
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