Pulmonary Embolism, Acute — Alteplase (Tissue Plasminogen Activator, tPA) — Clinical Pathway: Emergency Department, ICU and Inpatient

Acute Pulmonary Embolism Clinical Pathway — Emergency Department, ICU and Inpatient

Alteplase (Tissue Plasminogen Activator, tPA)

Thrombolysis may be considered for children with High Risk and Intermediate Risk PE in discussion with a hematologist or PERT.

This dosing protocol has been used in adults and has not been studied in children.

Alteplase Clinical Practice Guideline

Contraindications to tPA

  • Major surgery within 7-10 days
  • Active bleeding
  • CNS surgery/trauma/ischemia/hemorrhage within 30 days
  • Platelet count < 75,000
  • Fibrinogen < 100
  • Uncontrolled hypertension
  • Severe coagulopathy

Note

Obtain head ultrasound in all infants < 1 month or head CT in older children whose neurologic status is difficult to assess.

tPA Dosing for Intermediate or High-risk PE

≥ 60 kg
  • 10 mg alteplase over 10 minutes
  • Followed by 90 mg over 2 hours
    • Note: This dose may be reduced to 40 mg over 2 hours in select patients in discussion with hematology
< 60 kg
  • 0.1 mg/kg, alteplase over 10 minutes
  • Followed by 0.9 mg/kg over 2 hours
    • Note: This dose is extrapolated from adults. Dosing may be higher or lower depending on risk of bleed or thrombosis