Tissue plasminogen activator (t-PA) for stroke
|Generic Name||Brand Name|
|tissue plasminogen activator (t-PA) or alteplase||Activase|
Why It Is Used
Tissue plasminogen activator can be used to treat some people who are having a stroke caused by a blood clot (ischemic stroke). It is given in a vein (intravenously, or IV) and in some cases may be given directly into an artery.
The medicine works best if it is given right away after stroke symptoms begin. Strict criteria must be met in order to use the medicine. The medicine can be used to prevent disability after a stroke.
Who should not take t-PA
T-PA dissolves blood clots, so giving it to someone who has bleeding in the brain can be life-threatening. A computed tomography (CT) scan of the head must be done before giving the medicine, to make sure there is no bleeding present in the brain.
People who have had prior bleeding problems, recent surgery, or have problems with blood clotting cannot take t-PA. Very high blood pressure, a recent bleeding ulcer, or brain cancer are other reasons not to use t-PA.
How Well It Works
Bleeding is a major side effect of tissue plasminogen activator. If t-PA is given to a person who has had bleeding within the brain, it increases the risk for bleeding into the brain, which increases the chance of death. This makes it very important to distinguish whether a person's stroke is caused by a clot or by a bleeding blood vessel before giving the medicine. Before this medicine is given, computed tomography (CT) scan of the head is used to make sure there is no bleeding inside the brain.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Tissue plasminogen activator should be given right away after the first symptoms of stroke start. The person and/or family members need to provide as much information as possible about what symptoms the person had and when they began. This helps determine whether giving t-PA would be helpful. If it has been too long since the symptoms started, the medicine is unlikely to benefit the person. Other strict criteria also must be met before the medicine can be given.
Most people who might benefit from the use of t-PA cannot get the medicine because they do not go to the hospital soon enough. The medicine works best when given right away after stroke symptoms start.1, 2
Before you are given t-PA, the doctor must explain its risks and benefits to you. You may need to sign a consent form before you take it.
T-PA should never be given to a person who has had a stroke caused by bleeding (hemorrhagic stroke). Before this medicine is given, a computed tomography (CT) scan of the head can help make sure there is no bleeding in the brain. A CT scan may also be done to look for damage caused by a blood clot that has blocked blood supply to part of the brain (ischemic stroke).
Medicines that interfere with normal clotting (anticoagulants or antiplatelets, such as aspirin) should not be used for 24 hours after receiving t-PA.
A CT scan of the head is usually repeated 24 hours after the medicine is given.
T-PA should be given only in hospitals that are equipped to take care of bleeding complications that this medicine may cause.
- Hacke W, et al. (2008). Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New England Journal of Medicine, 359(13): 1317–1329.
- Del Zoppo GJ, et al. (2009). Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: A science advisory from the American Heart Association/American Stroke Association. Stroke, 40(8): 2945–2948.
Last Updated: January 8, 2009
Author: Monica Rhodes