In alteplase dosing for acute ischemic stroke, what percentage is given as bolus?

• A. 100% as bolus.
• B. 50% as bolus, remainder over 30 minutes.
• C. 0% bolus; all over 60 minutes.
• D. 10% as bolus, remainder over 60 minutes.

Answer: (D)

In acute ischemic stroke, alteplase is given with a specific dose pattern: the total dose is 0.9 mg/kg (maximum 90 mg). Ten percent of that total is given as a bolus, usually over about 1 minute, and the remaining ninety percent is infused over the next 60 minutes. This combination delivers rapid clot-dissolving action while controlling the infusion.

For example, a patient weighing 70 kg would receive a total of 63 mg. The bolus would be 6.3 mg given quickly, and the remaining 56.7 mg would be infused over 60 minutes. This matches the dosing approach described as 10% bolus with the remainder over 60 minutes.