How to give thrombolytics


A great question came up in the zones. We see and likely should be comfortable with the dosing of Alteplase for CVA. Grady is a renowned Stroke Center and I would certainly have any of my family members come to the Marcus Stroke and Neuroscience Center if they were having a stroke. The fact that our Neurology colleagues come down and meet the patients basically at the door is a huge credit to the amazing care we can provide these patients.

The questions was: what is the dosing for thrombolytics in not just CVA, but also in STEMI and PE?

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  • For CVA: Alteplase 0.9 mg/kg, 10% given over 60 seconds and the rest given within the next 60 minutes
  • For STEMI: you need to know above or below 67 kg
    • < 67 kg: 15 mg bolus, THEN 45 mg over next 30 min, THEN 30 mg over the next 60 min
    • > 67 kg: 15 mg bolus, THEN 50 mg over next 30 min, THEN 35 mg over the next 60 min
  • For PE: 100 mg over 2 hours


For PE the Emergency Medicine provider probably cares more about unstable PE, which is not what this dosing is for. In unstable PE there are no guidelines that have been agreed upon, and furthermore there is a question of how long you need to wait to see an effect after you have given the medication. Perhaps a good topic for a future post…!

Hope this was helpful! Remember, we REALLY want you to leave a comment. Even if its just to say hello!


~ Mene Demestihas, MD

@menelaosMD & @EmoryEM