TABLE 2204 Criteria for Intravenous Thrombolysis in Ischemic Stroke

DOSING, ADMISSION, AND COMPLICATIONS The total dose of rt-PA is 0.9 mg/kg, with a maximum dose of 90 mg; 10 percent of the dose is administered as a bolus, with the remaining amount infused over 60 min. Blood pressure and neurologic checks should be assessed every 15 min for 2 h after starting the infusion. Table 220-5 outlines the emergent management of hypertension following thrombolytic administration. No aspirin or heparin is given in the initial 24 h following treatment. Patients should be admitted to an ICU setting familiar with the use of thrombolytic drugs and neurologic monitoring. Intracerebral bleeding should be suspected as the cause of any neurologic worsening until repeat CT imaging is obtained. If bleeding is suspected, a CBC with platelet count, coagulation studies, fibrinogen and type and crossmatch for 4 units (U) packed red blood cells, 4 U cryoprecipitate or fresh-frozen plasma, and 1 U single-donor platelets should be obtained. An emergent hematology and neurosurgical consultation, as necessary, is appropriate. Patients may be cared for at hospitals without in-house neurosurgical availability as long as access, or transport, to neurosurgical care can be arranged while a patient is stabilized.

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