Acute ischaemic stroke
Refer to local board guidelines or product literature.
Alteplase is an alternative for use when tenecteplase is unsuitable due to hypersensitivity to the active substance or to any of the excipients or to gentamicin (a trace residue from the manufacturing process).
Initially 900micrograms/kg (max. per dose 90mg), treatment must begin within 4.5 hours of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion.
Initially 900micrograms/kg (max. per dose 90mg), treatment must begin within 4.5 hours of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion.
Initially 900micrograms/kg (max. per dose 90mg), treatment must begin within 4.5 hours of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion.
Prescribing Notes:
- Thrombolytic treatments must be used in strict accordance with detailed protocols in a specialist acute stroke unit.
- Tenecteplase is approved for use in adults for the thrombolytic treatment of acute ischaemic stroke within 4.5 hours from last known well and after exclusion of intracranial haemorrhage.
- Tenecteplase is approved for off-label use in wake-up stroke or onset over 4.5 hours in the context of advanced imaging providing evidence of salvageable tissue (Except in those with minor acute ischaemic stroke(NIHSS 0-5) with proven intracranial occlusion or perfusion abnormality beyond 4.5 hours).
- Alteplase is approved for the fibrinolytic treatment of acute ischaemic stroke. For use within 4.5 hours after onset of the stroke symptoms and after exclusion of intracranial haemorrhage.
History Notes
27/02/2025
Addition of Tenecteplase, ERFC Feb 25
16/02/2022
East Region Formulary content agreed.
Patients will be commenced on aspirin 300mg daily for 14 days, then switched to secondary prevention with clopidogrel 75mg daily.
Within 48 hours of ischaemic stroke 300mg daily for 14 days.
75mg daily, after 14 days of aspirin.
Prescribing Notes:
- Treatment with aspirin 300mg daily for 14 days needs to be completed first before switching to clopidogrel 75mg daily.
- In minor ischaemic stroke dual anti-platelet therapy may be considered if the risk of intra or extracranial haemorrhage is low. The recommended dual antiplatelet therapy is a loading dose of aspirin 300mg and clopidogrel 300mg on day 1 followed by aspirin 75mg once daily for up to 21 days and clopidogrel 75mg once daily to continue thereafter for secondary prevention.
- In high risk TIA dual anti-platelet therapy for 21 days may be considered if the risk of intra or extracranial haemorrhage is low. The recommended dual antiplatelet therapy is a loading dose of aspirin 300mg and clopidogrel 300mg on day 1 followed by aspirin 75mg once daily for up to 21 days and clopidogrel 75mg once daily to continue thereafter for secondary prevention. Secondary prevention with a statin is also indicated.
- The co-prescribing of clopidogrel with omeprazole or esomeprazole should be avoided due to the potential antagonism of the anti-platelet effect. If concomitant use of clopidogrel and a PPI is necessary, then lansoprazole would be an appropriate choice.
History Notes
16/02/2022
East Region Formulary content agreed.