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**alteplase + unfractionated heparin** is a combination of two agents—a fibrinolytic (alteplase, also known as tissue plasminogen activator or tPA) and an anticoagulant (unfractionated heparin). Alteplase is a recombinant enzyme that converts plasminogen to plasmin, which dissolves fibrin in thrombi, resulting in clot breakdown. Unfractionated heparin potentiates antithrombin III, which inactivates thrombin and factor Xa, thereby inhibiting further clot development and propagation. This combination is frequently used in the acute treatment of thrombotic events, such as myocardial infarction, pulmonary embolism, and certain cases of acute ischemic stroke, as well as for catheter-directed thrombolysis. The pairing of alteplase and unfractionated heparin increases the risk of bleeding and requires careful patient selection and monitoring.[1][3][4]
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