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)