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:
==Medication Dosing==
# Stop tpa infusion
{{MedicationDose
# Stat head CT
| drug = Tranexamic acid
## if no bleeding resume tpa
| dose = 15mg/kg IV in 250mL over 20 min
## If bleeding check labs, consider fibrinogen replacement
| route = IV
# Recheck pt/ptt, platelets, fibrinogen levels
| context = If ongoing hemorrhage after blood products
# Prepare 6- 8 units cryoprecipitate
| indication = Post-tPA Hemorrhage in CVA
# Prepare 6- 8 units platelets
| population = Adult
}}


==Source==
==See Also==
6/06 MISTRY
*[[CVA (tPA Criteria)]]
*[[CVA (Main)]]


[[Category:Heme/Onc]]
==References==
[[Category:Neuro]]
<references/>
[[Category:Neurology]]
[[Category:Critical Care]]

Latest revision as of 05:33, 22 March 2026

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

Medication Dosing

Tranexamic acid 15mg/kg IV in 250mL over 20 min IV

See Also

References

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