Post-tPA Hemorrhage in CVA

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

• Stop tPA
• Head CT
  • If no bleeding: resume tPA
  • If bleeding:
    • Consider fibrinogen replacement
    • Recheck CBC, coags fibrinogen levels
    • Prepare 6-8 units cryoprecipitate
    • Prepare 6-8 units platelets

See Also

• CVA (tPA Criteria)
• CVA (Main)