Sign Out
Clearance of occluded catheters and shunts
Adult: Doses are administered locally into the shunt or catheter/cannula lumen only. Thrombosed arteriovenous haemodialysis shunts: 5,000-25,000 units/mL via a local forced periodic infusion (pulse spray) into both branches of the shunt. May be repeated every 30-45 minutes if necessary, up to Max of 2 hours. Max total dose: 250,000 units. Thrombosed intravascular catheters and cannulae: Via catheter lock regimen: Dissolve 5,000-25,000 units in a sufficient volume of 0.9% NaCl that will fill the lumen of the catheter/cannula. Instil the sufficient volume to fill the catheter or cannula lumen; lock or clamp off the lumen for 20-60 minutes, then aspirate the lysate. Repeat the procedure if needed. Alternatively, via infusion regimen: Using a 1,000-2,500 units/mL solution in 0.9% NaCl, infuse up to Max of 250,000 units into the catheter or cannula lumen over 90-180 minutes. Dosage recommendations may vary among individual products or between countries (refer to product-specific guidelines).
Intra-arterial
Pulmonary embolism
Adult: For acute massive cases: Initially, 15,000 units/kg as a bolus inj into the pulmonary artery; may be repeated up to 2 times at 24-hour intervals. Subsequent inj may be adjusted according to the plasma fibrinogen concentrations produced by the previous inj.
Intra-arterial
Peripheral arterial thromboembolism
Adult: In acute occlusive peripheral arterial disease with limb-threatening ischaemia: Initially, 4,000 units/minute via a local intra-arterial catheter-directed graded infusion for 2-4 hours or until antegrade flow restoration; continue infusion with 1,000-2,000 units/minute until complete lysis or up to Max of 48 hours. Alternatively, infuse 2,000 units/mL solution (dissolve 500,000 units in 250 mL 0.9% NaCl) into the clot via a catheter at 4,000 units/minute rate for 2 hours. Perform angiography; if blood flow has not resumed, advance the catheter into the occluded vessel and continue infusion at the same rate for another 2 hours. May be repeated up to 4 times if needed. When blood flow is reestablished, partially withdraw the catheter and continue infusion at a rate of 1,000 units/minute until the clot has completely lysed. Usually, a dose of 500,000 units over 8 hours is sufficient. Dosage recommendations may vary among individual products or between countries (refer to product-specific guidelines).
Intravenous
Pulmonary embolism
Adult: For acute massive cases: Initially, 4,400 units/kg via infusion in a peripheral vein over 10-20 minutes; followed by 4,400 units/kg/hour continuous infusion for 12 hours.
Intravenous
Deep vein thrombosis
Adult: For extensive acute proximal cases: Initially, 4,400 units/kg via infusion in a peripheral vein over 10-20 minutes; followed by 100,000 units/hour continuous infusion for 48-72 hours. Alternatively, initial dose of 4,400 units/kg (dissolved in 15 mL of 0.9% NaCl) infused in a peripheral vein over 10 minutes; followed by 4,400 units/kg/hour continuous infusion for 12-24 hours. Dosage recommendations may vary among individual products or between countries (refer to product-specific guidelines).
