Medical Editor: John P. Cunha, DO, FACOEP
Activase (alteplase) is an enzyme, which works to break up and dissolve blood clots that can block arteries, used in the treatment of an acute heart attack or pulmonary embolism. The most common side effect of Activase is bleeding, including gastrointestinal bleeding, genitourinary bleeding, bruising, nosebleed, and bleeding gums. Other side effects of Activase include:
- low blood pressure (hypotension),
- mild fever, or
- allergic reactions (swelling, rash, hives).
The recommended total dose of Activase is based upon patient weight, not to exceed 100 mg. Activase may interact with blood thinners, or aspirin. Tell your doctor all medications and supplements you use. During pregnancy, Activase should be used only if prescribed. It is unknown if this drug is passes into breast milk. Consult your doctor before breastfeeding.
Our Activase (alteplase) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
The following adverse reactions are discussed in greater detail in the other sections of the label:
- Bleeding [see CONTRAINDICATIONS , WARNINGS AND PRECAUTIONS]
- Orolingual Angioedema [see WARNINGS AND PRECAUTIONS]
- Cholesterol Embolization [see WARNINGS AND PRECAUTIONS]
- Reembolization of Deep Venous Thrombi during Treatment for Acute Massive Pulmonary Embolism [see WARNINGS AND PRECAUTIONS].
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
The most frequent adverse reaction associated with Activase in all approved indications is bleeding.
Acute Ischemic Stroke (AIS)
In clinical studies in patients with AIS (Studies 1 and 2) the incidence of intracranial hemorrhage, especially symptomatic intracranial hemorrhage, was higher in Activase-treated patients than in placebo patients. A dose-finding study of Activase suggested that doses greater than 0.9 mg/kg may be associated with an increased incidence of intracranial hemorrhage.
The incidence of all-cause 90-day mortality, intracranial hemorrhage, and new ischemic stroke following Activase treatment compared to placebo are presented in Table 3 as a combined safety analysis (n=624) for Studies 1 and 2. These data indicate a significant increase in intracranial hemorrhage following Activase treatment, particularly symptomatic intracranial hemorrhage within 36 hours. There was no increase in the incidences of 90-day mortality or severe disability in Activase-treated patients compared to placebo.
Table 3: Combined Safety Outcomes for Studies 1 and 2
|All-Cause 90-day Mortality||64 (20.5%)||54 (17.3%)||0.36|
|Total ICHa||20 (6.4%)||48 (15.4%)||<0.01|
|Symptomatic||4 (1.3%)||25 (8.0%)||<0.01|
|Asymptomatic||16 (5.1%)||23 (7.4%)||0.32|
|Symptomatic Intracranial Hemorrhage within 36 hours||2 (0.6%)||20 (6.4%)||<0.01|
|New Ischemic Stroke (3-months)||17 (5.4%)||18 (5.8%)||1.00|
|a Within trial follow-up period. Symptomatic intracranial hemorrhage was defined as the occurrence of sudden clinical worsening followed by subsequent verification of intracranial hemorrhage on CT scan. Asymptomatic intracranial hemorrhage was defined as intracranial hemorrhage detected on a routine repeat CT scan without preceding clinical worsening.
b Fisher’s Exact Test.
Bleeding events other than intracranial hemorrhage were noted in the studies of AIS and were consistent with the general safety profile of Activase. In Studies 1 and 2, the frequency of bleeding requiring red blood cell transfusions was 6.4% for Activase-treated patients compared to 3.8% for placebo (p=0.19).
Although exploratory analyses of Studies 1 and 2 suggest that severe neurological deficit (National Institutes of Health Stroke Scale [NIHSS > 22]) at presentation was associated with an increased risk of intracranial hemorrhage, efficacy results suggest a reduced but still favorable clinical outcome for these patients.
Acute Myocardial Infarction (AMI)
For the 3-hour infusion regimen in the treatment of AMI, the incidence of significant internal bleeding (estimated as > 250 mL blood loss) has been reported in studies in over 800 patients (Table 4). These data do not include patients treated with the Activase accelerated infusion.
Table 4: Incidence of Bleeding in 3-Hour Infusion in AMI Patients
|Total Dose ≤100 mg|
The incidence of intracranial hemorrhage in AMI patients treated with Activase is presented in Table 5.
Table 5: Incidence of Intracranial Hemorrhage in AMI Patients
|Dose||Number of Patients||Intracranial Hemorrhage (%)|
|100 mg, 3-hour||3272||0.4|
|≤ 100 mg, accelerated||10,396||0.7|
A dose of 150 mg or greater should not be used in the treatment of AMI because it has been associated with an increase in intracranial bleeding.
Pulmonary Embolism (PE)
For acute massive pulmonary embolism, bleeding events were consistent with the general safety profile observed with Activase treatment of AMI patients receiving the 3-hour infusion regimen.
Allergic-type reactions, e.g., anaphylactoid reaction, laryngeal edema, orolingual angioedema, rash, and urticaria have been reported. When such reactions occur, they usually respond to conventional therapy.
The following adverse reactions have been identified during post-approval use of Activase. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These reactions are frequent sequelae of the underlying disease, and the effect of Activase on the incidence of these events is unknown.
Acute Ischemic Stroke
Acute Myocardial Infarction
Arrhythmias, AV block, cardiogenic shock, heart failure, cardiac arrest, recurrent ischemia, myocardial reinfarction, myocardial rupture, electromechanical dissociation, pericardial effusion, pericarditis, mitral regurgitation, cardiac tamponade, thromboembolism, pulmonary edema. These events may be life threatening and may lead to death. Nausea and/or vomiting, hypotension and fever have also been reported.
Pulmonary reembolization, pulmonary edema, pleural effusion, thromboembolism, hypotension. These events may be life threatening and may lead to death. Fever has also been reported.
Read the entire FDA prescribing information for Activase (Alteplase)
© Activase Patient Information is supplied by Cerner Multum, Inc. and Activase Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.