Template:TPA Stroke: Difference between revisions
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===[[Alteplase]]=== | |||
*NOTE - in stroke, do not give [[aspirin]] until 24 hours after giving tPA, as ASA with tPA does not improve outcomes and increases bleed risk<ref>Zinkstok SM, Roos YB, ARTIS Investigators . Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet (2012) 380(9843):731–7.10.1016/S0140-6736(12)60949-0.</ref> | |||
*Do not give acutely heparin (or any anticoagulation) if giving tPA<ref>Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review. Rob A. van de Graaf, Vicky Chalos, Gregory J. del Zoppo, Aad van der Lugt, Diederik W. J. Dippel, Bob Roozenbeek. Front Neurol. 2018; 9: 238.</ref> | |||
Dosing: | |||
*0.9mg/kg IV (max 90mg total) | |||
**10% of dose is administered as bolus; rest is given over 60min | |||
*Neuro check Q15min x 2hr | |||
*No anticoagulation/antiplatelets x 24hr | |||
*Blood pressure (keep SBP <180, DBP <105) | |||
If SBP is >180-230 or DBP is >120: | |||
*[[Nicardipine]] 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR | |||
*[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR | |||
*[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min | |||
If BP not controlled by above measures: | |||
*[[Nitroprusside]] 0.5–10mcg/kg/min | |||
*Continuous arterial monitoring advised | |||
*Use with caution in patients with hepatic or renal insufficiency | |||
Latest revision as of 17:09, 21 April 2019
Alteplase
- NOTE - in stroke, do not give aspirin until 24 hours after giving tPA, as ASA with tPA does not improve outcomes and increases bleed risk[1]
- Do not give acutely heparin (or any anticoagulation) if giving tPA[2]
Dosing:
- 0.9mg/kg IV (max 90mg total)
- 10% of dose is administered as bolus; rest is given over 60min
- Neuro check Q15min x 2hr
- No anticoagulation/antiplatelets x 24hr
- Blood pressure (keep SBP <180, DBP <105)
If SBP is >180-230 or DBP is >120:
- Nicardipine 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR
- Labetalol 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
- Labetalol 10mg IV followed by infusion at 2–8 mg/min
If BP not controlled by above measures:
- Nitroprusside 0.5–10mcg/kg/min
- Continuous arterial monitoring advised
- Use with caution in patients with hepatic or renal insufficiency
- ↑ Zinkstok SM, Roos YB, ARTIS Investigators . Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet (2012) 380(9843):731–7.10.1016/S0140-6736(12)60949-0.
- ↑ Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review. Rob A. van de Graaf, Vicky Chalos, Gregory J. del Zoppo, Aad van der Lugt, Diederik W. J. Dippel, Bob Roozenbeek. Front Neurol. 2018; 9: 238.