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Alteplase (trade names Activase, Actilyse) is a thrombolytic drug, used to treat acute myocardial infarctions (heart attacks) and other severe conditions caused by blood clotting by breaking up the blood clots that cause them.

Clinical data
Trade namesActivase, Actilyse
License data
  • US: C (Risk not ruled out)
ATC code
Legal status
Legal status
CAS Number
  • none
Chemical and physical data
Molar mass59042.3 g/mol g·mol−1

It is a tissue plasminogen activator. It is approved by the US Food and Drug Administration for the treatment of myocardial infarction with ST-elevation (STEMI), acute ischemic stroke (AIS), acute massive pulmonary embolism, and occluded central venous access devices (CVAD).[1][2][3]

Medical usesEdit

The primary uses of alteplase, as approved by the FDA, include acute ischemic stroke, acute myocardial infarction, and acute massive pulmonary embolism.[4]

In regards to acute myocardial infarction, a new randomized controlled trial published in January 2019 specifically looking at patients with acute STEMI, showed there was no reduction in microvascular obstruction when adjunctive low dose intracoronary alteplase was administered during the primary PCI. [5]

Mechanism of actionEdit

Alteplase is a serine protease that assists fibrin in the conversion of plasminogen to plasmin. When in the systemic circulation, alteplase binds to fibrin in a thrombus and initiates fibrinolysis. [4]


  1. ^ "Thrombolytic Therapy: Background, Thrombolytic Agents, Thrombolytic Therapy for Acute Myocardial Infarction". 2017-05-02.
  2. ^ Monograph for Activase.
  3. ^ Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. 2017. Actilyse-Pulver und Lösungsmittel zur Herstellung einer Injektions- oder Infusionslösung. ISBN 3-85200-196-X.
  4. ^ a b Activase [package insert]. South San Francisco, CA: Genentech, Inc.; 2018.
  5. ^ McCartney, Peter (January 2019). "Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients with Acute Myocardial Infarction". JAMA. 321: 56–68.