Thrombolytics for acute ischemic stroke

Revision as of 22:39, 29 October 2010 by Robot (talk | contribs) (Created page with "==Inclusion Criteria== 1) Clinical diagnosis of stroke 2) Clear onset (last witnessed well) <3 hours 3) Age >18 yrs ==Exclusion Criteria== (ABSOLUTE) 1) BP Systolic...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

Inclusion Criteria

1) Clinical diagnosis of stroke

2) Clear onset (last witnessed well) <3 hours

3) Age >18 yrs


Exclusion Criteria

(ABSOLUTE)

1) BP Systolic >185, diastolic >110 (can receive 1-3 doses anti-hypertensive)

2) PTT >34, PT >15, or INR >1.7

3) Platelet count <100,000

4) Blood Glucose <50 or >400 mg/dl

5) Minor stroke or rapidly resolving stroke

6) Hemorrhage or edema on non-con head CT

7) Suspected SAH

6) Seizure at onset of stroke

7) Heparin treatment during the past 48 hours with an elevated PTT

8) Evidence of acute myocardial infarction


(RELATIVE)

5) History of prior intracranial hemorrhage, neoplasm, AVM or aneurysm

6) Major surgery/trauma within <14 days

7) Stroke or serious head injury within 3 months

8) GI/GU bleeding within <21 days

9) Lactation or pregnancy within <30 days

(ADDITONAL PER HARBOR NEURO)

10) AMI or pericarditis (ECG)

11) Aggressive treatment needed to control BP

12) Lumbar puncture within <7 days

13) Occult blood in urine or stool (UA + Guiac)


ECASS III Exclusion Criteria (if giving tPA between 3-4.5 hours)

Age > 80

Baseline NIHSS > 25

Any oral anticoagulant use

History of prior stroke and DM


Studies Needed

1) Head CT

2) CBC

3) PT/PTT

4) Glu check

5) ECG

6) Icon


Giving tPA

1) Alteplase (Activase/tPA): 0.9mg/kg (max 90mg total) IV; Give 10% as bolus over 1 min, remainder by continous infusion over 60min

2) Neuo check Q15min x 2hrs, Q30min x6hrs, Q1hr x 16hrs

3) Keep BP <185/95 (labetalol/nipride gtt if nec)

4) NO anticoatulation/antiplatelet agents x24hrs

5) Stop tPA if worsening neuro exam --> STAT head-CT


See Also

Neuro: post-tPA Hemmorhage


Source

1/26/06 DONALDSON (adapted from Lampe, Tintinali)

2/20/10 PANI (ACEP/AAN Guidelines--class B recommendations)