Use of Actilyse in acute ischaemic stroke
Actilyse® reconstitution
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Reconstitution Actilyse 50mg
What are the service implications of using Actilyse® in clinical practice?
Following a stroke, "time is brain" and patients need to be admitted as an acute medical emergency if they are to benefit from treatment with Actilyse®.
Given the strict therapeutic time window for the use of Actilyse® and the necessary process of patient selection, the following key practices are included in the recommendations of TARGET: Stroke, based on "Get with the guidelines: Stroke patient management":
- Advance notification of the emergency medical services.
- Rapid triage and notification of the stroke unit and one-call mobilisation of the acute stroke care team prior to the arrival of the patient.
- An acute care setting staffed by physicians experienced in the diagnosis and management of acute stroke including the administration of Actilyse®, which can be pre-mixed and prepared before the patient’s arrival.
- Rapid, priority access to imaging facilities (computed tomography or magnetic resonance imaging) together with personnel experienced in the detection of intracranial haemorrhage, early signs of significant infarction and other intracranial pathology.
- Centres should have a written protocol specifying requirements for treating and monitoring Actilyse® patients and procedures for emergency situations.
- Results of continuous monitoring of response times, door-to-needle times, and Actilyse® administration rates should be feedback to the stroke team to ensure that they meet their goals.
(AHA/ASA 2010: TARGET: STROKE Resource Manual. Time lost is brain lost.)
How to use Actilyse®
Give as soon as possible after symptom onset and within 4.5* hours of stroke symptom onset
Total dose 0.9 mg/kg (maximum 90 mg):
10% by i.v. bolus, remainder by i.v. infusion over 60 minutes
Avoid aspirin or i.v. heparin in the 24 hours after treatment with Actilyse®
*In some countries, Actilyse® is only licensed for use within the first 3 hours of stroke symptom onset. Please check your local licensing regulations for Actilyse®.
Dosage | Contra-indications | CT imaging | Other imaging | |
---|---|---|---|---|
ESO# |
| In patients with a suspected stroke or TIA, urgent brain imaging (CT or MRI) should be obtained to guide routine thrombolysis treatment with rt-PA | The use of multimodal imaging may be useful for patient selection for thrombolysis but is not recommended for routine clinical practice | |
AHA/ASA* |
| I.V. administration of streptokinase is not recommended for management of ischaemic stroke
| Brain imaging (either CT or MRI) should be interpreted by an experienced clinician before starting thrombolytic therapy | Additional information in the diagnosis of ischaemic stroke may be provided by multimodal CT or MRI |
*AHA/ASA (The American Heart Association) Del Zoppo et al. Stroke 2009;40:2945‑2948.
#ESO (The European Stroke Organisation) www.eso-stroke.org.
Current guidelines for acute stroke management, such as the European Stroke Organisation (ESO) recommendations and the American Stroke Association guidelines recommend the use of intravenous rt-PA within 4.5 hours of onset of ischaemic stroke as Level 1 and Class A recommendation.