NR 293
Administration of Alteplase to Combat a Stroke
Chamberlain College of Nursing
NR 293 – Pharmacology
Alteplase is a thrombolytic agent approved for pulmonary embolism, myocardial
infarction, and ischemic stroke (Reed, Kerndt, & Nicolas, 2020). Alteplase is also known as a
tissue plasminogen activator, tPA. The way tPA works due to plasminogen converting to
plasmin; this results in a lysis formation. Alteplase is only available in an IV form. The
administration starts by giving a bolus of 10% of the total dose over one minute, then the
remaining amount id administered over the next 60 minutes (Reed, Kerndt, & Nicolas, 2020). To
be most effective, the patient needs to receive this medication as soon as possible and needs to be
within 3 – 4.5 hours of the onset of symptoms. Before administration, blood work should be
taken, including a CBC, aPTT, and a serum fibrinogen test; these should be repeated after
alteplase therapy (Reed, Kerndt, & Nicolas, 2020). The nurse also needs to obtain a set of vitals,
including a neurological assessment before administration then should periodically check the
patients' vital signs and neurological status throughout the infusion.
Since alteplase is used to "bust" a clot, resulting in anticoagulation, resulting in the
thinning of the blood, there are some severe contraindications. The usage of tPA is
contraindicated and should be avoided in individuals with any hemorrhage, internal bleeding,
severe uncontrolled hypertension, and a history of a stroke within the last three months (Reed,
Kerndt, & Nicolas, 2020). The nurse administering the medication and the patient should be
aware that if toxicity occurs, most likely resulting in severe bleeding, there is no antidote;
Administration of Alteplase to Combat a Stroke
Chamberlain College of Nursing
NR 293 – Pharmacology
Alteplase is a thrombolytic agent approved for pulmonary embolism, myocardial
infarction, and ischemic stroke (Reed, Kerndt, & Nicolas, 2020). Alteplase is also known as a
tissue plasminogen activator, tPA. The way tPA works due to plasminogen converting to
plasmin; this results in a lysis formation. Alteplase is only available in an IV form. The
administration starts by giving a bolus of 10% of the total dose over one minute, then the
remaining amount id administered over the next 60 minutes (Reed, Kerndt, & Nicolas, 2020). To
be most effective, the patient needs to receive this medication as soon as possible and needs to be
within 3 – 4.5 hours of the onset of symptoms. Before administration, blood work should be
taken, including a CBC, aPTT, and a serum fibrinogen test; these should be repeated after
alteplase therapy (Reed, Kerndt, & Nicolas, 2020). The nurse also needs to obtain a set of vitals,
including a neurological assessment before administration then should periodically check the
patients' vital signs and neurological status throughout the infusion.
Since alteplase is used to "bust" a clot, resulting in anticoagulation, resulting in the
thinning of the blood, there are some severe contraindications. The usage of tPA is
contraindicated and should be avoided in individuals with any hemorrhage, internal bleeding,
severe uncontrolled hypertension, and a history of a stroke within the last three months (Reed,
Kerndt, & Nicolas, 2020). The nurse administering the medication and the patient should be
aware that if toxicity occurs, most likely resulting in severe bleeding, there is no antidote;
