Appropriate patient selection for Activase® is vital in the treatment of acute ischemic stroke (AIS)

Determine patient eligibility by incorporating the following steps:

Identify potentially eligible patients 6
  • Activase is indicated for the treatment of AIS 
  • Exclude intracranial hemorrhage as the primary cause of stroke signs and symptoms prior to initiation of treatment 
  • Initiate treatment as soon as possible, but within 3 hours after symptom onset
Confirm patients have no contraindications to treatment 6

Do not administer Activase to treat AIS in the following situations in which the risk of bleeding is greater than the potential benefit

Contraindicationsa

  • Current intracranial hemorrhage (ICH)
  • Subarachnoid hemorrhage
  • Active internal bleeding
  • Recent (within 3 months) intracranial or intraspinal surgery or serious head trauma
  • Presence of intracranial conditions that may increase the risk of bleeding (e.g., some neoplasms, arteriovenous malformations, or aneurysms)
  • Bleeding diathesis
  • Current severe uncontrolled hypertension
Consider potential drug interactions 6

Drug interactions

  • The interaction of Activase with other cardioactive or cerebroactive drugs has not been studied
  • Anticoagulants and antiplatelet drugs increase the risk of bleeding if administered prior to, during, or after Activase therapy
  • In the post-marketing setting, there have been reports of angioedema in patients (primarily patients with AIS) receiving concomitant angiotensin-converting enzyme inhibitors.

a The 2018 AHA/ASA scientific guidelines for the inclusion and exclusion criteria for IV alteplase in AIS also advises against treatment with IV alteplase in patients: 2

  • With a platelet count <100,000/mm, international normalized ratio (INR) >1.7, activated partial thromboplastin time (aPTT) >40 seconds, or prothrombin time (PT) >15 seconds 
  • Who have a history of warfarin use and an INR >1.7 and/or a PT >15 seconds 
  • Who have received a treatment dose of low-molecular-weight heparin within the previous 24 hours 
  • Who are taking direct thrombin inhibitors or direct Xa inhibitors, unless the laboratory tests are normal or the patient has not received a dose of these agents for >48 hours