Thrombolytic regimens, doses, and contraindications

MoleculeRegimenContraindications to fibrinolysis
rtPA100 mg over 2 hAbsolute
History of haemorrhagic stroke or stroke of unknown origin
Ischaemic stroke in previous 6 months
Central nervous system neoplasm
Major trauma, surgery, or head injury in previous 3 weeks
Bleeding diathesis
Active bleeding
Transient ischaemic attack in previous 6 months
Oral anticoagulation
Pregnancy or first post-partum week
Non-compressible puncture sites
Traumatic resuscitation
Refractory hypertension (systolic BP >180 mmHg)
Advanced liver disease
Infective endocarditis
Active peptic ulcer
0.6 mg/kg over 15 min (maximum dose 50 mg)a
Streptokinase250 000 IU as a loading dose over 30 min, followed by 100 000 IU/h over 12–24 h
Accelerated regimen: 1.5 million IU over 2 h
Urokinase4400 IU/kg as a loading dose over 10 min, followed by 4400 IU/kg/h over 12–24 h
Accelerated regimen: 3 million IU over 2 h

BP: blood pressure; IU: international units; rtPA, recombinant tissue-type plasminogen activator. aThis is the accelerated regimen for rtPA in pulmonary embolism; it is not officially approved, but it is sometimes used in extreme haemodynamic instability such as cardiac arrest.