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Thrombolytic — Catheter-Directed Thrombolysis / Peripheral Arterial Occlusion

Alteplase (Peripheral Arterial / DVT Use)

Brand names: Actilyse

Alteplase is a recombinant tissue plasminogen activator used in vascular practice for catheter-directed thrombolysis of acute peripheral arterial occlusion and selected cases of extensive deep vein thrombosis.

Dosing — not shown for this use

The product information we hold does not support a dose for this page's specific use, route or population, so none is shown. Follow your local or national guideline, and confirm against the product SmPC.

Clinical monograph

How it works

It is a fibrin-specific plasminogen activator that converts plasminogen to plasmin on the thrombus surface, dissolving the fibrin clot.

Prescribing in practice

  • The principal hazard is major haemorrhage, including intracranial bleeding, so active bleeding, recent surgery or trauma, and other defined bleeding risks are absolute contraindications.
  • Careful patient selection and a defined exclusion checklist are essential before peripheral or catheter-directed thrombolysis.
  • Concurrent anticoagulant and antiplatelet therapy further increases bleeding risk and requires specialist management.

Monitoring

Monitor for bleeding, vital signs, neurological status and, with catheter-directed therapy, the limb perfusion and coagulation parameters per protocol.

Counselling the patient

  • This is a clot-dissolving treatment given under close supervision because of bleeding risk.
  • Report any new bleeding, severe headache or weakness immediately.

Evidence & guidelines

Catheter-directed thrombolysis with alteplase is an established option for acute limb ischaemia in suitable patients, balanced against bleeding risk.

Reference: STILE Trial; TOPAS Trial; ATTRACT Trial 2017; ESC/ESVS Peripheral Arterial Disease Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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