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CDT Protocol with Alteplase and Reteplase

This document outlines a protocol for catheter-directed thrombolysis (CDT) using Tissue Plasminogen Activator (TPA) with Reteplase and Alteplase. It details dosage instructions, including bolus and infusion rates, as well as additional medications like Heparin and Dexamethasone. The protocol emphasizes monitoring fibrinogen levels and aPTT during treatment.

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hossam
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14 views1 page

CDT Protocol with Alteplase and Reteplase

This document outlines a protocol for catheter-directed thrombolysis (CDT) using Tissue Plasminogen Activator (TPA) with Reteplase and Alteplase. It details dosage instructions, including bolus and infusion rates, as well as additional medications like Heparin and Dexamethasone. The protocol emphasizes monitoring fibrinogen levels and aPTT during treatment.

Uploaded by

hossam
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd

protocol for catheter-directed thrombolysis (CDT) using Tissue Plasminogen

Activator

Reteplase:
2 vials 20 ml (1U/ml)
Give 5 U bolus
Then 0.75/hr for 20 hrs:
(The remaining 15 ml are diluted with 5ml saline and inject 1ml/hr so it will
finish in 20 hrs)

Alteplase: ( actilyse ) ok
* 5 mg bolus, then
* 1-1.5 mg/h for 12-24 hours :
0.5 - 0.75 mg every 1/2 hr by piston ( give 5 ml of solution each gush )

Into the sheath


Heparin 100 ml every hr by pump

No urine catheter, unless inserted prior to drug

- Give prophylactic Dexamethazone 4 mg (1 amp.) + Avil 10 mg (1 amp.) before


initiating TPA.
- Start Heparin infusion of 100 units / hour into the sheath through a separate
syringe pump.
- The TPA vial contains 50 mg of Alteplase; dilute it in 500 ml normal saline
bottle to achieve 0.1 mg/ml concentration of the Alteplase in the bottle. Put it
in the refrigerator.
- Give a bolus dose of 5 mg (50 ml) of the Alteplase into the catheter over 30 min
either by infusion pump or the accompanying syringe pistol.
-If there are no any adverse effects after 10 minutes start the infusion.
- The infusion dose range is 1-1.5 mg / hour [10-15 ml / hour] for 12-24 hours.
- Fill a 20 c.c. syringe from the Alteplase diluted bottle and plug it into the
pistol.
- Calibrate the pistol to give 5 - 7.5 ml per shot according to the preferred
dosage.
- Give one pistol shot every ½ hour; 0.5-0.75 mg every shot [5-7.5 ml / ½ hour].
- Continue this protocol for 12-24 hours according to the total dose and results.

Maintain fibrinogen levels above 100 mg/dL


Maintain aPTT range of 50 to 70 seconds

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