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2.10 Stable angina, acute coronary syndromes and fibrinolysis

2.10.2 Fibrinolytic drugs

Alteplase injection - acute ischaemic stroke; massive/submassive PE
Streptokinase injection (MI in patients >75 years)
Tenecteplase (1st choice in acute MI)
Urokinase (available as an unlicensed use for the management of occluded in-dwelling vascular catheters, i.e. venflon)
Reteplase injection – discontinued


Please refer to the Trust Coronary Care Guidelines (via the document search on Flo).


1. Alteplase is available for acute stroke thrombolysis. It may be given up to 4.5 hours after the onset of symptoms. Intracranial haemorrhage must be excluded by appropriate imaging techniques. See NICE TA 264.

2. For early thrombolysis in the treatment of acute myocardial infarction, see NICE TA 52.

For link to BNF section: 2.10 Stable angina, acute coronary syndromes, and fibrinolysis