Tissue plasminogen activator (t-PA) for stroke

Examples

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Brand Name	Generic Name
Activase	tissue plasminogen activator (t-PA) or alteplase

How It Works

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Tissue plasminogen activator (t-PA) dissolves blood clots.

Why It Is Used

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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

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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

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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 before giving the medication. Computed tomography (CT) scan of the head is used to make sure there is no bleeding inside the brain before this medication is given.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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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 aspirin) 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.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Adams HP, et al. (2005). Guidelines for the early management of patients with ischemic stroke. 2005 guideline update: A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke, 36: 916–921.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Updated	March 6, 2007