Alteplase (Peripheral Arterial / DVT Use)

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.