Tissue plasminogen activator (t-PA) for stroke
Examples
Generic Name Brand Name tissue plasminogen activator (t-PA) or alteplase Activase How It Works
Tissue plasminogen activator (t-PA) dissolves blood clots.
Why It Is Used
Tissue plasminogen activator can be used to treat some people who are having a stroke caused by a blood clot (ischemic stroke
). It is given in a vein (intravenously, or IV) and in some cases may be given directly into an artery.
The medication should be given within 3 hours after stroke symptoms begin. Strict criteria must be met in order to use the medication.1 The medication can be used to prevent disability after a stroke.
Who should not take t-PA
T-PA dissolves blood clots, so giving it to someone who has bleeding in the brain can be life-threatening. A computed tomography (CT) scan of the head must be done before giving the medication, to make sure there is no bleeding present in the brain.
People who have had prior bleeding problems, recent surgery, or have problems with blood clotting cannot take t-PA. Very high blood pressure, a recent bleeding ulcer, or brain cancer are other reasons not to use t-PA.
How Well It Works
Studies have shown that:1
- T-PA helped people with strokes caused by clots (ischemic strokes) when it was given within 3 hours after stroke symptoms began.
- T-PA did not decrease the chance of having another stroke in the future.
Side Effects
Bleeding is a major side effect of tissue plasminogen activator. If t-PA is given to a person who has had bleeding within the brain, it increases the risk for bleeding into the brain, which increases the chance of death. This makes it very important to distinguish whether a person's stroke is caused by a clot or by a bleeding blood vessel
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Tissue plasminogen activator should be given within the first 3 hours after the first symptoms of stroke start. The person and/or family members need to provide as much information as possible about what symptoms the person had and when they began. This helps determine whether giving t-PA would be helpful. If symptoms have gone on for more than 3 hours, the medication is unlikely to benefit the person. Other strict criteria also must be met before the medication can be given.
Most people who might benefit from the use of t-PA cannot get the medication because they do not go to the hospital soon enough (within 3 hours after the start of symptoms).
Before you are given t-PA, the doctor must explain its risks and benefits to you. You may need to sign a consent form before you take it.
T-PA should never be given to a person who has had a stroke caused by bleeding (hemorrhagic stroke). A computed tomography (CT) scan of the head can help make sure there is no bleeding in the brain before this medication is given. A CT scan may also be done to look for damage caused by a blood clot that has blocked blood supply to part of the brain (ischemic stroke).
Medications that interfere with normal clotting (anticoagulants or antiplatelets, such as ASA) should not be used for 24 hours after receiving t-PA.1
A CT scan of the head is usually repeated 24 hours after the medication is given.
This medication should be given only in hospitals that are equipped to take care of bleeding complications that it may cause.
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: May 14, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |