UMEM Educational Pearls

Category: Neurology

Title: Alteplase Administration Errors in Stroke

Keywords: acute ischemic stroke, alteplase, tPA, thrombolysis, error (PubMed Search)

Posted: 4/15/2021 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

  • Alteplase administration in acute ischemic stroke (AIS) has been associated with errors.
  • A recent study looked at the types of errors that occurred at regional hospitals and Comprehensive Stroke Centers.
  • 19.8% (133/676) of patients had an error associated with alteplase administration with the majority occurring at regional hospitals without stroke certification.
    • The most common error was over-dosage of alteplase, occurring in 5% (36) of patients.
    • Other common errors included under-dosage, infusion errors, and apparent contraindications.
  • The most common contributing factor leading to the error was incorrect calculation.
  • Administration error was associated with higher rate of hemorrhagic conversion (12.7% vs. 7.1%, p=0.04).

Bottom Line: Alteplase administration in acute ischemic stroke is associated with errors, most commonly with over-dosage of the medication.


Dancsecs KA, Nestor M, Bailey A, Hess E, Metts E, Cook AM. Identifying errors and safety considerations in patients undergoing thrombolysis for acute ischemic stroke. Am J Emerg Med. 2021;47:90-94.

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