Post-tPA Hemorrhage in CVA: Difference between revisions

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Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure.
==Background==
*Consider post-tPA [[ICH]] if patient develops:
**[[AMS|Decreased LOC]]
**Worsening neurologic exam
**Increased [[weakness]]
**New [[headache]]
**Sudden rise in [[hypertension|BP]]
*May also have [[GI bleed]], mucosal bleeding


==Management==
*Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
*STAT [[Head CT]]
*If no bleeding: resume tPA
*If post-tPA ICH present
**Obtain baseline labs: CBC, D-dimer, type and screen, fibrinogen. Check INR 15 minutes after FFP administration (see below) and platelets 15 min after platelet administration (see below)
**Administer cryoprecipitate 10 units for fibrinogen replacement
***If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
**Administer FFP 20 ml/kg
***If INR > 1.4, give additional 20 ml/kg)
**Administer 2-5 packs platelets
***If platelets <100,000, give additional PRN to achieve Plt > 100,000
**STAT neurosurgery consult
**Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures


If bleeding occurs after tpa given,
==See Also==
*[[CVA (tPA Criteria)]]
*[[CVA (Main)]]


1- stop tpa infusion
==References==
 
<references/>
2- stat CT- if no bleeding, resume tpa.
[[Category:Neurology]]
 
[[Category:Critical Care]]
3- check new pt/ptt, platelets, fibrinogen lvls
 
4- prepare 6- 8 units cryoprcptte
 
5- prerare 6- 8 units platelets
 
6- if ICH present on CT, check labs and consider fibrinogen replacement
 
 
CVA GENERAL
 
- asa only. Heparin not help CVA- only possible TIA
 
- control BP <185/110 with labetolol 10mg iv
 
- CT scan might be negative if hyperacute
 
- hyperglycemia worsens outcome- no glucuse in fluids and use insulin prn
 
- no ASA if TPA to be given
 
- cardiac dysrrhythmia by increased symp tone, catechol release, decreased parasymp tone.
 
 
6/06 MISTRY
 
 
 
 
[[Category:Neuro]]

Latest revision as of 20:42, 27 November 2019

Background

Management

  • Immediately Stop tPA, even on suspicion of post-tPA hemorrhage
  • STAT Head CT
  • If no bleeding: resume tPA
  • If post-tPA ICH present
    • Obtain baseline labs: CBC, D-dimer, type and screen, fibrinogen. Check INR 15 minutes after FFP administration (see below) and platelets 15 min after platelet administration (see below)
    • Administer cryoprecipitate 10 units for fibrinogen replacement
      • If fibrinogen returns > 150, discontinue, if < 150, recheck in 1 hr and if still low administer additional 20 units
    • Administer FFP 20 ml/kg
      • If INR > 1.4, give additional 20 ml/kg)
    • Administer 2-5 packs platelets
      • If platelets <100,000, give additional PRN to achieve Plt > 100,000
    • STAT neurosurgery consult
    • Consider TXA 15 mg/kg IV in 250 ml x 20 min if ongoing hemorrhage after above measures

See Also

References

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