front-loaded tPA regimen
Last reviewed 07/2022
The GUSTO I study showed that accelerated administration of t-PA in association with intravenous heparin gives optimum results:
- accelerated administration of t-PA:
- intravenous bolus dose of 15 mg
- followed by an infusion of 0.75 mg per kilogram of body weight over a 30-minute period (maximum 50 mg)
- then an infusion of 0.5 mg per kg over a 60-minute period (maximum 35 mg)
- intravenous heparin:
- bolus dose of 5000 u
- followed by a continuous infusion of 1000 u per hour
- 300 mg of aspirin should be chewed, followed by 75-150 mg/day indefinitely
The accelerated tPA regimen should be considered in patients who:
- are < 50 yr old
- have large infarcts
- present within 4 hr of the onset of symptoms
- are normotensive (systolic b.p. < 140 mmHg)