Name of the Procedure:

Injection, alteplase recombinant, 1 mg (J2997)

Summary

Injection of alteplase recombinant (commonly known as tPA or tissue plasminogen activator) involves administering a medication designed to dissolve blood clots. This procedure is typically carried out in emergency settings to quickly restore blood flow.

Purpose

The primary purpose of this injection is to treat acute ischemic stroke, myocardial infarction (heart attack), and pulmonary embolism. The goal is to rapidly dissolve blood clots, restore normal blood flow, and minimize damage to affected tissues.

Indications

• Acute ischemic stroke within a specified time window from symptom onset
• Acute myocardial infarction (ST-elevation MI)
• Massive pulmonary embolism with hemodynamic instability

Patient criteria include:

• Confirmation of clot presence via diagnostic imaging
• No contraindications such as recent surgery or bleeding disorders

Preparation

• Diagnostic imaging (e.g., CT scan, angiography) to confirm clot presence
• Blood tests to assess clotting function and rule out bleeding risks
• Patient consent and explanation of risks and benefits
• No specific fasting required unless otherwise instructed by healthcare providers

Procedure Description

1. Initial assessment and diagnostic imaging to confirm eligibility.
2. Intravenous (IV) line insertion for medication administration.
3. Administration of alteplase recombinant via IV infusion over a set period (usually 60 minutes for stroke).
4. Continuous monitoring of vital signs and neurological status.
5. Use of technology such as infusion pumps to ensure precise delivery.

Typically, no anesthesia or sedation is required, as this is a minimally invasive procedure.

Duration

The medication infusion usually takes about 60 minutes. Preparation and monitoring extend the overall time to approximately 2-3 hours.

Setting

Performed in an emergency room or intensive care unit (ICU) within a hospital due to the need for continuous monitoring and rapid response capabilities.

Personnel

• Emergency room physician or intensivist
• Nurses specialized in acute care or ICU settings
• Radiologists for initial diagnostic imaging
• Pharmacist for medication preparation

Risks and Complications

• Common risks: Bleeding at the injection site, minor allergic reactions
• Rare but severe risks: Intracranial hemorrhage, systemic bleeding, severe allergic reactions (anaphylaxis)
• Complications are managed with immediate cessation of the drug and supportive care measures.

Benefits

• Rapid dissolution of dangerous blood clots
• Restoration of normal blood flow, which can significantly reduce tissue damage and improve recovery outcomes
• Benefits are often realized within hours, depending on the condition being treated.

Recovery

• Continuous monitoring in an ICU or stroke unit for at least 24 hours
• Regular neurological assessments and blood tests to monitor for any side effects
• Expected recovery time varies: patients may start noticing improvements within hours to days.
• Follow-up appointments for ongoing assessment and secondary prevention measures.

Alternatives

• Mechanical thrombectomy for stroke if within suitable time window and clot location allows
• Antiplatelet and anticoagulant medications for long-term management
• Each option has its own risks and benefits; mechanical thrombectomy may offer immediate clot removal but requires specialized equipment and expertise.

Patient Experience

• Patients may feel a mild discomfort during IV insertion and infusion.
• Most patients will be closely monitored, minimizing awareness of the procedure itself.
• Pain management typically involves routine painkillers for any discomfort post-procedure.
• Comfort measures include ensuring patient is relaxed and informing them about each step to alleviate anxiety.