Front-loaded tPA regimen

The GUSTO I study showed that accelerated administration of t-PA in association with intravenous heparin gives optimum results:

• accelerated administration of t-PA:
  • intravenous bolus dose of 15 mg
  • followed by an infusion of 0.75 mg per kilogram of body weight over a 30-minute period (maximum 50 mg)
  • then an infusion of 0.5 mg per kg over a 60-minute period (maximum 35 mg)
    
    
• intravenous heparin:
  • bolus dose of 5000 u
  • followed by a continuous infusion of 1000 u per hour
    
    
• 300 mg of aspirin should be chewed, followed by 75-150 mg/day indefinitely

The accelerated tPA regimen should be considered in patients who:

• are < 50 yr old
• have large infarcts
• present within 4 hr of the onset of symptoms
• are normotensive (systolic b.p. < 140 mmHg)