Generic Name

Jantoven

Mechanism

• Recombinant tPA analogue that binds selectively to fibrin‑bound plasminogen.
• Converts plasminogen to plasmin → proteolytic degradation of fibrin → clot dissolution.
• Engineered with six amino‑acid substitutions to enhance fibrin specificity and prolong half‑life relative to alteplase.
• Requires intravenous (IV) single‑bolus delivery; rapid onset of action (~10 min).

Pharmacokinetics

• Bioavailability: ~100 % (IV).
• Distribution: Primarily plasma‑borne; negligible tissue uptake beyond clot site.
• Metabolism: Degraded by proteolytic enzymes; no major hepatic or renal pathways.
• Elimination half‑life: 5–6 min (initial plasma phase); overall systemic elimination ~35 min.
• Renal/hepatic impairment: No dose adjustment required; safety profile unchanged.

Indications

• Acute, first‑time STEMI within 12 h of symptom onset (preferably <6 h).
• Unreliable or delayed percutaneous coronary intervention (PCI) access.
• Primary thrombolytic therapy when PCI not immediately available and risk of ischemic injury outweighs bleeding risk.

Contraindications

• Absolute contraindications:
• Active internal bleeding or known bleeding diathesis.
• Cerebral neoplasm, recent intracranial hemorrhage.
• Recent major surgery or trauma within 14 days.
• Myocardial infarction within 90 days, or cardiogenic shock.
• Relative contraindications:
• Severe hypertension >210/110 mmHg.
• Recent stroke or uncontrolled arrhythmias.
• Pregnancy (teratogenic risk).
• Warnings: Monitor for intrasinusoidal bleeding (e.g., intracranial, retroperitoneal).

Dosing

• Adult weight‑based dosing (kg ≥ 50 kg):
• 0.1 mg/kg IV bolus (max 10 mg) over ≤10 s.
• *Note*: No infusion; single rapid injection.
• Pediatric and special populations: Weight‐based dosing per drug label; always consult specific guidelines.
• Preparation: Reconstitute with 9 mL normal saline; draw into syringe; verify dose immediately before administration.

Adverse Effects

• Allergic reactions: Rash, urticaria, anaphylaxis (rare).
• Bleeding complications:
• Major: intracerebral hemorrhage (≈1–3 % in STEMI trials).
• Minor: mucosal bleeding, hematuria.
• Hemorrhagic retinopathy (rare).
• Hypotension – monitor blood pressure during administration.

Monitoring

• Vital signs: BP, HR during and after administration.
• Cardiac rhythm: Continuous ECG monitoring; watch for arrhythmias.
• Hemostasis: Observe for signs of bleeding; check hemoglobin/hematocrit 1–2 h post‑bolus.
• Imaging: Repeat ECG/echocardiography to confirm reperfusion and rule out hemorrhage.
• Laboratory: No routine labs required unless complications suspected.

Clinical Pearls

• Early administration is critical: Benefits plateau after 9 h; best therapy within 3 h of symptom onset.
• Rapid IV technique matters: A true bolus (1 h delay.
• Weight accuracy: In under‑weight or obese patients, use actual measured weight; under‑dosing can compromise reperfusion, over‑dosing escalates hemorrhage risk.

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• *All information reflects current (2026) prescribing data. Refer to the official product label for the most updated guidance.*