reteplase, recombinant

Action

Converts plasminogen to plasmin, which in turn breaks down fibrin and fibrinogen, thereby dissolving thrombus

Availability

Injection: Retavase Half-Kit-one vial of 10.4 units (18.1 mg)/vial; Retavase Kit-two vials of 10.4 units (18.1 mg)/vial

Indications and dosages

➣ Acute myocardial infarction

Adults: 10 units by I.V. bolus over 2 minutes, repeated in 30 minutes

Off-label uses

• Pulmonary embolism

Contraindications

• Hypersensitivity to drug or alteplase

• Active internal bleeding

• Bleeding diathesis

• Recent intracranial or intraspinal surgery or trauma

• Intracranial neoplasm

• Arteriovenous malformation or aneurysm

• Severe uncontrolled hypertension

• History of cerebrovascular accident

Precautions

Use cautiously in:

• previous puncture of noncompressible vessels, major surgery, obstetric delivery, organ biopsy, trauma, hypertension, conditions that may cause left-sided heart thrombus (including mitral stenosis), acute pericarditis, subacute bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, cerebrovascular disease, severe hepatic or renal dysfunction, septic thrombophlebitis or occluded AV cannula at a seriously infected site, other conditions in which bleeding poses a significant hazard

• concurrent use of oral anticoagulants (such as warfarin)

• patients older than age 75

• pregnant or breastfeeding patients.

Administration

See If patient shows signs or symptoms of bleeding or anaphylaxis after first bolus dose, withhold second bolus and contact prescriber immediately.

• Use only diluent supplied (preservative-free sterile water for injection) to reconstitute drug into colorless solution of 1 unit/ml.

• If drug foams, let it sit until foam subsides.

• Don't use solution if it is discolored or contains visible precipitates.

• Don't give with other drugs in same I.V. line. Know that drug is incompatible with heparin.

Adverse reactions

CNS: intracranial hemorrhage

CV: arrhythmias, hemorrhage

GI: nausea, vomiting, GI bleeding

GU: hematuria

Hematologic: anemia, bleeding tendency

Other: fever, bleeding at puncture sites

Interactions

Drug-drug. Anticoagulants, indomethacin, phenylbutazone, platelet aggregation inhibitors (such as abciximab, aspirin, dipyridamole): increased risk of bleeding

Drug-diagnostic tests. Hemoglobin: decreased level

International Normalized Ratio, partial thromboplastin time, prothrombin time: increased

Drug-herbs. Ginkgo, many other herbs: increased risk of bleeding

Patient monitoring

See Check closely for signs and symptoms of bleeding in all body systems. Monitor coagulation studies and CBC.

• Monitor ECG for arrhythmias caused by coronary thrombolysis.

• Assess neurologic status to detect early signs and symptoms of intracranial hemorrhage.

Patient teaching

• Teach patient about drug's anticoagulant effect. Review safety measures to avoid injury, which can cause uncontrolled bleeding.

See Instruct patient to immediately report signs and symptoms of bleeding problems.

• Tell patient he'll undergo frequent blood testing during therapy.