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Table 5. Treatment of AIS in Adults*: IVT
Alteplase: Infuse 0.9 mg/kg (maximum dose 90 mg ) over 60 min, with 10% of the dose
given as a bolus over 1 min.
Tenecteplase: Push 0.25 mg/kg (up to maximum 25 mg ) based on patient body weight
†
:
Patient weight (kg) TNK (mg) Volume TNK to be administered (mL)
<60 kg 15 3
60 kg to <70 kg 17.5 3.5
70 kg to <80 kg 20 4
80 kg to <90 kg 22.5 4.5
≥90 kg 25 5
Admit the patient to an intensive care or stroke unit for monitoring.
If the patient develops severe headache, acute hypertension, nausea, or vomiting or has
a worsening neurological examination, discontinue the infusion (if IV alteplase is being
administered) and obtain an emergency head CT scan.
Measure BP and perform neurological assessments every 15 min during and aer
IVT administration for 2 h, then every 30 min for 6 h, then hourly until 24 h aer IV
alteplase treatment.
Increase the frequency of BP measurements if SBP is >180 mm Hg or if DBP is >105 mm
Hg ; administer antihypertensive medications to maintain BP at or below these levels.
Delay placement of nasogastric tubes, indwelling bladder catheters, or intraarterial
pressure catheters if the patient can be safely managed without them.
Obtain a follow-up CT or MRI scan at 24 h aer IVT before starting anticoagulants or
antiplatelet agents.
* Dosing for pediatric patients has not been determined.
†
If <50kg and accurate weight is known, dosing per 1-kg band may be used. Do not delay
thrombolysis to obtain exact weight — timely treatment is critical. With estimated weights,
dosing per 1-kg band is not necessarily safer than 10-kg band dosing.
AIS indicates acute ischemic stroke; BP, blood pressure; CT, computed tomography; DBP,
diastolic blood pressure; IV, intravenous; IVT, intravenous thrombolysis; MRI, magnetic
resonance imaging ; and SBP, systolic blood pressure.
