Post-tPA Hemorrhage in CVA: Difference between revisions
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==Background== | ==Background== | ||
*Consider if | *Consider post-tPA [[ICH]] if patient develops: | ||
**Decreased LOC | **[[AMS|Decreased LOC]] | ||
**Increased weakness | **Worsening neurologic exam | ||
**New headache | **Increased [[weakness]] | ||
**Sudden rise in BP | **New [[headache]] | ||
**Sudden rise in [[hypertension|BP]] | |||
*May also have [[GI bleed]], mucosal bleeding | |||
==Management== | ==Management== | ||
*Stop tPA | *Immediately Stop tPA, even on suspicion of post-tPA hemorrhage | ||
*Head CT | *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== | ==See Also== | ||
| Line 21: | Line 28: | ||
==References== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Neurology]] | ||
[[Category:Critical Care]] | |||
Latest revision as of 20:42, 27 November 2019
Background
- Consider post-tPA ICH if patient develops:
- Decreased LOC
- Worsening neurologic exam
- Increased weakness
- New headache
- Sudden rise in 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