tPA for Stroke

For a stroke, tPA (tissue plasminogen activator) is an IV treatment that breaks down blood clots that block blood flow to your brain. It’s a type of thrombolytic agent.

The U.S. Food and Drug Administration (FDA) approves the use of two tPAs specifically for ischemic strokes within three hours of symptoms starting:

• Alteplase (Activase®)
• Tenecteplase (TNKase®)

Tissue plasminogen activator is often an effective treatment to get blood flowing to your brain again. This can limit the risk of brain damage from a stroke. But you must get the medication soon after having stroke symptoms for it to help. This is why it’s key to act fast if you or someone near you has signs of a stroke.

What happens during this treatment?

First, your healthcare team will make sure you meet the criteria to get tPA:

• You’ll receive a CT scan to make sure you have an ischemic stroke, not a hemorrhagic (brain bleed) stroke.
• You must be able to get the treatment within three hours of first developing stroke symptoms. In some cases, providers may give tPA up to four and a half hours after symptom onset. But this may increase your risk of serious side effects and reduce the effectiveness of the medication.

Your team will also go over your medical history to see if there are reasons why tPA may not be safe for you. Some reasons you can’t get this treatment include:

• Significant head trauma or prior stroke within the past two or three months
• History of brain bleeds
• Presence of a brain tumor, arteriovenous malformation or aneurysm
• Elevated blood pressure
• Active internal bleeding

This isn’t a complete list. Your healthcare team will consider many factors before deciding if tPA is safe for you.

If you meet the criteria, a healthcare provider will give tPA through an IV in your arm. With alteplase, you get the dose over the period of an hour. You get one dose of tenecteplase within a few seconds.

What are the potential benefits and risks of this treatment?

tPA is the standard treatment for ischemic stroke. It’s effective at dissolving blood clots blocking blood flow to your brain. Studies suggest that those who receive tPA within four and a half hours of symptoms start having a reduced risk of major stroke-related disability. The greatest benefit is seen when treatment is given within the first three hours.

This treatment comes with risks, though. The most frequent severe complications of tPA therapy are related to bleeding. It can cause serious internal bleeding in your:

• Brain
• Gastrointestinal system
• Respiratory system
• Urinary and reproductive systems

It’s also possible to develop an allergic reaction to the medication.

Your healthcare team will closely monitor you for any complications.

How long will it take for me to feel better?

Everyone’s body responds differently to a stroke, even with tPA as a part of treatment. What you can expect after a stroke depends on a few factors, like:

• Which type of ischemic stroke you had
• Which areas of your brain it affected
• How quickly it was treated
• Your overall health

Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.