a. Advanced age (over 75)

b. Pregnancy

c. Hypertension - 180/110 or either separately

d. Acute pericarditis or subacute bacterial endocarditis

e. Recent major surgery or trauma at a non-compressible site

f. Any conditions producing a prolonged prothrombin time

g. Any other conditions in which bleeding would constitute a significant risk or management problem.

Dose:

Administered by intravenous infusion therapy for one dose only.

67 Kg or > - 100 mg over 90 minutes - administered as 15 mg IV bolus followed by 50 mg over 30 minutes and 35 mg over the next 60 minutes.

< 67 Kg - 15 mg IV bolus followed by 0.75 mg/kg (not to exceed 50 mg) over 30 minutes and then 0.5 mg/kg (not to exceed 35 mg) over the next 60 minutes.

Anticoagulants (heparin, aspirin, dipyridamole) will be administered concurrently or following therapy (within 24 hours) with Alteplase;

Monitor:

1. Excessive bleeding from any puncture sites

2. ECG - reperfusion arrhythmias

Outcome:

1. Patient responds favorably to therapy (relief of symptoms of MI)

2. Patient is monitored appropriately during therapy

3. Patient does not experience any major bleeding events.