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Ask A Pharmacist: What is the clot-busting drug for stroke treatment?

May 18, 2017 | By Lisa Schwenk
Published in: Question Answer, Stroke

tPA is the clot-busting drug given to treat ischemic stroke

May is National Stroke Awareness Month. At Augusta Health, stroke care is coordinated through our Stroke Team, and multidisciplinary group that includes physicians, nurses, physical therapists, pharmacists, speech therapists, occupational therapists, health educators and other medical professionals. The team focuses not just on the treatment of those who have experienced a stroke, but also on prevention of stroke through educating the community about symptoms and risk factors.

Mary Beth Linstra, PharmD
Mary Beth Linstra, PharmD

Answer provided by Mary Beth Linstra, PharmD, clinical staff pharmacist and member of Augusta Health’s Stroke Team. She earned her Doctorate of Pharmacy at Campbell University School of Pharmacy, and has been a pharmacist for 15 years. She is a part of Augusta Health’s Stroke Team because “It is rewarding to be part of a team that focuses on improving patient care for such a life-altering medical event. I enjoy working with the team to help improve how quickly we are able to get life-saving medications to our patients.”

The clot-busting drug that may be given to treat ischemic stroke is called alteplase, or brand name Activase. You may also hear it called tPA, which is short for tissue plasminogen activator.

An ischemic stroke happens when a blood clot blocks a vessel supplying blood to the brain. Alteplase (tPA) works by dissolving the blood clot and improving blood flow to the part of the brain being deprived of blood and oxygen. When given quickly after an ischemic stroke begins, alteplase (tPA) can save lives and reduce the long-term effects of stroke.

Many people miss out on this brain-saving treatment because they don't arrive at the hospital in time. This is why it is very important that you seek treatment as soon as possible when stroke symptoms start. Alteplase (tPA) must be given within 3 hours of start of symptoms, or up to 4.5 hours in certain eligible patients. This is the time frame that has been found to be safest and most effective.

Alteplase (tPA) is given through an IV in the arm and is dosed based on your weight. It is given in two steps – first a small dose is given IV push over one minute, and then an IV infusion is given over one hour.

Because alteplase (tPA) works by dissolving clots, it can also cause unwanted bleeding. This is one of the main possible side effects of receiving alteplase (tPA), so you will want to report any signs of bleeding or severe headache right away.

Before receiving alteplase (tPA), you will be asked about your medical history. Recent brain bleeding, internal bleeding, brain or spinal surgery, or serious head trauma may prevent you from being a candidate for alteplase (tPA). Also, your doctor will want to know if you are on any blood thinners such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), or edoxaban (Savaysa). In some cases, you may not be a candidate for alteplase (tPA) if you are on a blood thinner. Your doctor will review this with you and determine if you are able to receive alteplase (tPA).

Hemorrhagic stroke is another less common type of stroke. Hemorrhagic stroke occurs when a weakened blood vessel in the brain ruptures and causes bleeding into the brain. When you are evaluated for stroke, a head CT or MRI will be done to check for bleeding in the brain. If you are found to have bleeding in the brain, alteplase (tPA) will not be given. Stopping the bleeding will be the treatment for hemorrhagic stroke.

Remember that acting F.A.S.T. to spot stroke symptoms and seeking treatment quickly can help save brain cells and save lives.

F – Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the smile lopsided or uneven?

A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S – Speech Difficulty: Is speech slurred? Is person unable to speak or hard to understand? As the person to repeat a simple sentence like 'The sky is blue'. Is the person able to repeat the words?

T – Time to Call 911: If someone shows any of these symptoms, even if they go away, call 911 and say, 'I think this is a stroke'. Don't delay!