The nurse caring for this patient will expect to give alteplase [Activase] within 2 hours. Tenecteplase may be administered after the first couple of hours of symptoms. Getting a request for an INR is not advised.
The fatality rate for MI has been reported to be 5.4% when alteplase is administered within 2 hours of the beginning of symptoms, as opposed to 9.4% when it is administered 4 to 6 hours after the onset of symptoms. It is not required to wait for the results of the cardiac enzyme tests before administering ASA at the first symptom of MI.
Heparin and aspirin may also be used with alteplase to treat myocardial infarction. Providers can choose from the following dose plans when using them for this indication: IV bolus accompanied by a 90-minute infusion or a 180-minute infusion.
Patients who weigh more than 67 kg should get a 15 mg IV bolus, followed by a 90 minute infusion of 50 mg over 30 minutes, and then a 60 minute infusion of 35 mg. Patients who weigh less than or equal to 67 kg should get a 15 mg bolus, then a weight-based 0.75 mg/kg infusion over 30 minutes to Patients, and then a 0.5 mg/kg infusion over 60 minutes. No more than 100 mg should be given in total.
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