Actilyse

Actilyse is the brand name for alteplase, a recombinant tissue plasminogen activator (rt-PA) used as a thrombolytic agent. Alteplase binds to fibrin in a thrombus and converts plasminogen to plasmin, initiating fibrinolysis and clot dissolution. It is produced by Boehringer Ingelheim and marketed in many countries for acute thrombotic events.

Actilyse is indicated for the treatment of acute ischemic stroke when given within a defined time window, most commonly within 4.5 hours of symptom onset. It is also used in the management of acute myocardial infarction (ST-elevation and non–ST-elevation) when a timely percutaneous coronary intervention is not available, and in the treatment of massive or high-risk pulmonary embolism with hemodynamic instability. It may be used off-label for other clot-related conditions after careful evaluation.

For acute ischemic stroke, the recommended dose is 0.9 mg/kg (maximum 90 mg) given as a 10% bolus IV injection, with the remaining 90% infused over 60 minutes. For STEMI, a regimen begins with a 15 mg IV bolus, followed by 0.75 mg/kg (maximum 50 mg) over 30 minutes, then 0.5 mg/kg (maximum 80 mg) over 60 minutes. For acute PE with shock or hypotension, typical dosing is 100 mg total infused intravenously over 2 hours. Dosing can vary by country and indication; clinicians follow local guidelines.

Actilyse carries a risk of major bleeding, including intracranial hemorrhage. It is contraindicated in active or recent intracranial hemorrhage, known intracranial neoplasm, intracranial or intraspinal surgery, recent major bleeding, or severe uncontrolled hypertension. Other contraindications include known bleeding diatheses, recent surgery, or significant thrombocytopenia. Anticoagulants and antiplatelet agents can increase bleeding risk; careful monitoring is required during and after administration.

It is administered in a hospital setting with continuous monitoring. Neurological status is closely watched after stroke, and bleeding precautions are followed. Imaging may be performed to assess for hemorrhagic transformation before and after therapy.