tPA (Alteplase) Stroke Dosing
Free tPA (alteplase) stroke dosing calculator for healthcare professionals. Calculate weight-based IV dose for acute ischemic stroke with bolus and infusion amounts per AHA/ASA 2024 guidelines.
About This Calculator
The tPA (tissue plasminogen activator) calculator, also known as the alteplase dosing calculator, helps healthcare professionals determine the correct intravenous dose of this thrombolytic medication for patients with acute ischemic stroke. This evidence-based tool follows the American Heart Association and American Stroke Association (AHA/ASA) guidelines for weight-based alteplase administration.
The standard dosing protocol uses a total dose of 0.9 mg/kg, with a strict maximum of 90 mg. The dose is divided into two components: a 10% bolus administered intravenously over 1 minute, followed by a 90% continuous infusion delivered over 60 minutes. For patients weighing 100 kg or more, the bolus is capped at 9 mg and the infusion at 81 mg. This weight-based approach ensures optimal therapeutic effect while minimizing the risk of intracranial hemorrhage, the most serious complication of thrombolytic therapy.
Time from symptom onset is critical for tPA eligibility. The standard treatment window is within 3 hours of symptom onset, extended to 4.5 hours for eligible patients based on imaging criteria. Before administration, healthcare providers must carefully screen for contraindications including recent surgery, active bleeding, uncontrolled hypertension, and anticoagulant use. Patients require intensive monitoring for at least 24 hours post-administration in a stroke unit or ICU setting.
This calculator is intended for use by qualified healthcare professionals as a clinical decision support tool. Always verify dosing against institutional protocols and current clinical guidelines. The 2024 AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke serve as the primary reference for dosing standards.
Frequently Asked Questions
What is tPA (alteplase) and how does it work?
tPA (tissue plasminogen activator), also known as alteplase, is a thrombolytic medication that dissolves blood clots by converting plasminogen to plasmin. It is the standard of care for acute ischemic stroke when administered within the therapeutic window, working by restoring blood flow to the affected brain tissue.
How is tPA dosed for acute ischemic stroke?
The standard tPA dose for acute ischemic stroke is 0.9 mg/kg intravenously, with a maximum total dose of 90 mg. Ten percent (10%) of the total dose is given as an IV bolus over 1 minute, and the remaining 90% is administered as a continuous IV infusion over 60 minutes.
What is the maximum dose of tPA?
The maximum total dose of tPA (alteplase) for acute ischemic stroke is 90 mg, regardless of patient weight. For patients weighing 100 kg or more, the bolus dose is capped at 9 mg and the infusion dose at 81 mg. Exceeding this maximum increases the risk of intracranial hemorrhage.
What are the contraindications for tPA administration?
Contraindications include recent intracranial surgery or trauma, active internal bleeding, suspected subarachnoid hemorrhage, intracranial neoplasm, recent ischemic stroke within 3 months, severe uncontrolled hypertension, and current use of anticoagulants with elevated INR. Always consult current AHA/ASA guidelines and institutional protocols.
When should tPA be administered after stroke onset?
tPA should be administered within 3 hours of acute ischemic stroke symptom onset for eligible patients. The therapeutic window may extend to 4.5 hours for selected patients based on imaging criteria and clinical guidelines from the AHA/ASA. Time-to-treatment is critical for better outcomes.
What monitoring is required after tPA administration?
Patients require close monitoring in an intensive care or stroke unit setting for at least 24 hours. Vital signs and neurological status are checked every 15 minutes during infusion, every 30 minutes for the next 6 hours, and then hourly for 24 hours. Blood pressure must be maintained below 180/105 mmHg to reduce bleeding risk.
Is the tPA calculator free to use?
Yes, this tPA calculator is completely free to use with no registration required. It is designed for healthcare professionals, including emergency physicians, neurologists, stroke nurses, and paramedics, to quickly and accurately calculate alteplase dosing for acute ischemic stroke patients.