View source for Template:TPA Stroke

===[[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