Health knowledge made personal
Join this community!
› Share page:
Go
Search posts:

What's the 'Code' Dose of tPA?

Posted Mar 14 2013 12:00am


Accuracy
Valid for practice

True to literature

Overall quality


Please peer-review rate this blog post by clicking on the stars.


Scenario
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?

Clinical Question
In the rare situation where fibrinolytics may be indicated in cardiac arrest from PE or Acute Myocardial Infarction (AMI), what's the dose?

Citation Study Design Condition Drug Dose Kurkciyan I, et al. Arch Intern Med 2000; 160:1529-35. Retrospective cohort PE Alteplase 100 mg (either two 50 mg boluses or 15 mg bolus followed by 85 mg over 90 min) Ruiz-Bailen M, et al. Resuscitation 2001; 51:97-101. Case series PE Alteplase 50 mg bolus, repeat 50 mg in 30 min Janata K, et al. Resuscitation 2003; 57:49-55. Retrospective cohort PE Alteplase 0.6-1.0 mg/kg bolus (up to 100 mg)




Lederer W, et al. Resuscitation 2001; 50:71-6. Retrospective cohort AMI Alteplase 100 mg (15 mg bolus followed by 85 mg over 90 min) Ruiz-Bailen M, et al. Intensive Care Med 2001; 27:1050-7. Retrospective cohort AMI Alteplase 100 mg (either two 50 mg boluses or 15 mg bolus followed by 85 mg over 90 min) Schreiber W, et al. Resuscitation 2002; 52:63-9. Retrospective cohort AMI Alteplase 100 mg (15 mg bolus followed by 85 mg over 90 min) Kurkciyan I, et al. J Intern Med 2003; 253:128-35. Retrospective cohort AMI Alteplase 100 mg (15 mg bolus followed by 85 mg over 90 min)




Bottiger BW, et al. Lancet 2001; 357:1583-5. Prospective observational Nontraumatic cardiac arrest Alteplase 50 mg bolus, repeat 50 mg in 30 min Abu-Laban RB, et al. N Engl J Med 2002; 346:1522-8. RCT Cardiac arrest from any cause Alteplase 100 mg over 15 min Fatovich DM, et al. Resuscitation 2004; 61:309-13. RCT Cardiac arrest from any cause Tenecteplase 50 mg bolus Bozeman WP, et al. Resuscitation 2006; 69:399-406. Prospective cohort Nontraumatic cardiac arrest Tenecteplase 0.5 mg/kg bolus Bottiger BW, et al. N Engl J Med 2008; 359:2651-62. RCT Cardiac arrest from any cause Tenecteplase 0.5 mg/kg bolus

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.
Follow me on Twitter (@PharmERToxGuy)



View the  real-time results of the Peer Review Demographics  form.
Post a comment
Write a comment: