Indication
STEMI when PCI unavailable within 120 min of first medical contact.
Preparation
100 mg reconstitute to 1 mg/mL.
Dilution
1 mg/mL (accelerated regimen)
Rate
15 mg IV bolus → 50 mg over 30 min → 35 mg over 60 min (max 100 mg, adjust for weight <65 kg).
Monitoring
- • Neuro obs q15 min × 2 h
- • BP q15 min
- • ECG for reperfusion markers
- • Hb, coagulation
Common errors
- • Concurrent full-dose LMWH bolus → bleeding
- • Missing contraindications (recent surgery, stroke, HTN >185/110)
Pearls
- • Give aspirin 300 mg + clopidogrel 300 mg + enoxaparin bolus 30 mg IV then 1 mg/kg SC (halve if ≥75 y)
- • Assess reperfusion at 60–90 min; rescue PCI if failed
