Overview
When Fibrinolysis Is the Reperfusion Plan
An occlusive coronary thrombus can convert viable myocardium into infarcted tissue minute by minute.
An occlusive coronary thrombus can convert viable myocardium into infarcted tissue minute by minute. Primary percutaneous coronary intervention (PCI) is preferred when it can be delivered promptly; when PCI cannot be performed within 120 minutes of first medical contact, fibrinolysis with alteplase becomes the time-critical reperfusion strategy. Alteplase is not a routine medication given after an abnormal ECG. It is a high-risk eligibility decision: the clinician must confirm the STEMI pattern and symptom window, exclude conditions that make bleeding unacceptable, calculate the correct regimen, and coordinate antithrombotic therapy and immediate transfer to a PCI-capable centre. The drug may reopen the culprit artery, but its fibrinolytic action can also disrupt haemostatic clots elsewhere. This lesson uses adult STEMI care and the Canadian alteplase product monograph as its prescribing anchor. Other thrombolytic indications, including acute ischemic stroke or massive pulmonary embolism, use different diagnostic criteria, doses, and monitoring pathways; do not transfer the STEMI regimen into those settings.