Post-tPA Hemorrhage in CVA
Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure.
If bleeding occurs after tpa given,
1- stop tpa infusion
2- stat CT- if no bleeding, resume tpa.
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
- 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.