Q: 52 year old male presented to ER with massive PE. Diagnosis is confirmed with CT Angio and bedside Echo showed RV strain. You decided to use Thrombolytics. Pharmacy informed you that none of the FDA approved thrombolytics are available (Alteplase, Urokinase and Streptokinase). Only available thrombolytic is Reteplase? 


Answer: Although Reteplase has not been approved by the FDA for PE (only approved for AMI), but it is widely used off label for life threatening PE. The dosing used is the same as for patients with AMI: 2 IV boluses of 10 U each, administered 30 minutes apart. No adjustment is required for patient's weight. 

Actually, Reteplase work more rapidly and tends to have less bleeding risk than alteplase.