a Department of Pharmacy , Marcus Stroke and Neuroscience Center, Grady Health System , Atlanta , GA , USA.
b Advocate Good Samaritan Hospital , Downers Grove , IL , USA.
Expert Opin Drug Saf. 2019 Feb;18(2):87-96. doi: 10.1080/14740338.2019.1573985.
Alteplase, reteplase, and tenecteplase are tissue plasminogen activators (TPA) approved for the management of acute myocardial infarction. Only alteplase is also approved for the treatment of acute ischemic stroke (AIS). The US Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can result in failure to treat patients with the intended agent and lead to potential overdose.
This review compares the molecular and clinical features of alteplase, reteplase, and tenecteplase (TNK), identifies factors contributing to medication errors among these agents, and provides steps to reduce medication errors.
Primary factors contributing to medication errors among tissue plasminogen activators include the use of the abbreviations 'TPA,' 'tPA,' or 'TNK' in written or verbal orders and use of these agents in similar settings (e.g. emergency departments and critical care areas). Steps to reduce the likelihood of accidental substitution of tenecteplase or reteplase for alteplase in patients with AIS include the use of full brand or generic names and inclusion of the indication in written and verbal orders, the addition of alerts in automated dispensing machines and ordering systems and use of stroke boxes containing alteplase and materials for administration.
阿替普酶、瑞替普酶和替奈普酶是组织型纤溶酶原激活剂（tPA），用于治疗急性心肌梗死。只有阿替普酶也被批准用于治疗急性缺血性脑卒中（AIS）。美国食品和药物管理局已收到报告称，在 AIS 患者中意外给予替奈普酶或瑞替普酶而非阿替普酶，这可能导致未能用预期药物治疗患者，并导致潜在的药物过量。
本综述比较了阿替普酶、瑞替普酶和替奈普酶（TNK）的分子和临床特征，确定了导致这些药物发生用药错误的因素，并提供了减少用药错误的步骤。
导致组织型纤溶酶原激活剂用药错误的主要因素包括在书面或口头医嘱中使用缩写“tPA”、“tPA”或“TNK”，以及在类似环境（如急诊科和重症监护区）中使用这些药物。减少 AIS 患者意外用替奈普酶或瑞替普酶替代阿替普酶的可能性的步骤包括使用完整的品牌或通用名，并在书面和口头医嘱中包含适应证，在自动化配药机和医嘱系统中添加警示，并使用含有阿替普酶和给药材料的脑卒中盒。
