| Alteplase, Activase, tPA
Alteplase (tPA, Activase) was the first recombinant tissue-type plasminogen activator and is identical to native tissue plasminogen activator. In vivo, tissue-type plasminogen activator is synthesized and made available by cells of the vascular endothelium. It is the physiologic thrombolytic agent responsible for most of the body's natural efforts to prevent excessive thrombus propagation. Alteplase is the fibrinolytic agent most familiar to emergency departments and is the lytic agent most often used for the treatment of coronary artery thrombosis, pulmonary embolism, and acute ischemic stroke.
In theory, alteplase should be effective only at the surface of fibrin clot. In practice, however, a systemic lytic state is seen, with moderate amounts of circulating fibrin degradation products and a substantial systemic bleeding risk.
The agent may be readministered as necessary, as it is not antigenic and almost never is associated with any allergic manifestations.
As of today, alteplase is the only thrombolytic drug approved for acute ischemic stroke.
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